Mid-Year Plan Changes 

Learn more about our advocacy position on the issue of mid-year insurance plan changes, including the solutions we endorse and current legislative trends. 

The Issue

  • When selecting a health plan, many people with chronic conditions make their decisions after carefully weighing a complex variety of factors, including plan cost, network adequacy, medication formulary adequacy, cost sharing, the availability of specialists, and the choice of hospitals.
  • Insurance plans sometimes change the available benefits of a policy and coverage of medications during the plan year, imposing new requirements, increasing cost sharing obligations, and making other changes that can disrupt the treatment of stable patients.
  • Without a major life event, a plan member may not be able to access coverage that best meets his or her treatment needs.
  • An insurance provider (insurer) unilaterally changing its coverage while requiring insured members to stay in the plan is tantamount to a "bait and switch" technique which we believe is inherently unfair.

The Solution

  • Legislation that keeps insurance coverage consistent and affordable during a plan year by preventing health insurers from making changes to benefits, coverage, or access during a plan year that result in a negative impact on members of a plan.
  • Advance notice of formulary changes that will occur during open enrollment.

Current Trends

To date, 4 (four) states have addressed formulary changes during a plan year through state legislation.

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