Does my insurance have to be renegotiated every year? in 2014 I carried a Gold Health Alliance policy in Illinois. Without my knowing Jan 2015 my policy was changed to a much higher deductible policy. I only found out this happened in the middle of January 2015 when I received new insurance cards. I was admitted to the hospital Jan 3rd with Influenza A and pneumonia. After finding out my policy had been switched I called the Illinois marketplace to go back to my Gold Health Alliance policy. I am now having to pay out 4000.00 out of pocket with none of that amount going towards the deductible because I corrected the policy. Health Alliance and the Illinois Marketplace do not take responsibility for the change of policy as of Jan 2015. I feel there is a major flaw in the system . My hope is that you may be able to help me get some answers.
You'll need to renew your health plan each year, even if it's on auto-renew you'll want to check the plan benefits and cost assistance amounts. If your plan isn't offered, and your state offers auto-renew, you can be moved to a similar plan with similar cost assistance. Similar isn't always truly comparable, and that is why it's important to check the new plan selection as soon as open enrollment starts each year.
In this case your insurer may be in the clear. Despite you perceiving the plan as inadequate there is only so bad a plan can be under the ACA (out-of-pocket maximums and deductibles are limited by law). Your initial plan would have covered your treatment in some way, but you are owing out-of-pocket without the amount being applied to cost sharing because you switched to a new plan. If it is with the same carrier you can try appealing this. You can also try getting put back on the original plan and seeing if that coverage could simply be paid for retroactively and you could be treated as on that initial plan. That however is a long shot. Certainly this is all worth talking to HealthCare.Gov about and appealing, but technically this is all legal and correct.