How Plan Crosswalks Work in the ACA Marketplace

When a marketplace plan is discontinued, your clients aren’t left to wonder how to obtain new coverage. They’re automatically transitioned, or “crosswalked,” to a new, similar plan.

Let’s discuss how these transitions work in the marketplace, things to be aware of with plan crosswalks, and why they occur.

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What Is a Crosswalk in Health Insurance?

In the health insurance industry, a plan crosswalk occurs when enrollees from a discontinued plan are transitioned to a new plan with similar coverages in the same tier. You may also hear this movement referred to by others as “health plan mapping,” but the Centers for Medicare & Medicaid Services (CMS) refers to this transition as a crosswalk.

Plan Crosswalks in the Marketplace

If an Affordable Care Act (ACA) carrier is no longer offering a particular plan, or is leaving the marketplace, your clients will typically be reassigned to a new plan, from the same carrier or a different carrier, with a similar network and the lowest premium.

Crosswalks hold true for all carriers and plans operating in the federal marketplace; however, they may not necessarily occur in state-run marketplaces. Each state-based marketplace reserves the right to crosswalk enrollees to a new plan or alert them that their coverage is ending if their plan is being discontinued. When a client receives this notification, they will be able to select a new plan during a Special Enrollment Period (SEP) to receive coverage.

Each state-based marketplace reserves the right to crosswalk enrollees to a new plan or alert them that their coverage is ending if their plan is being discontinued.

How Your Clients Can Avoid Being Crosswalked

Before a plan is discontinued or a plan exits the marketplace, your client will receive written notification that these changes are happening. They will likely receive this notification in the mail a few months in advance of the OEP. Encourage your client to stay up to date on all communications from their insurer.

If your client receives notification that their coverage will be changing, they’ll be able to select a new plan within an SEP. Remind your client to select new coverage within the 60-day timeframe if their new crosswalked plan is not ideal. Your client can also select new coverage during the OEP.

By selecting new coverage, your client does maintain more control over their insurance. However, it is the goal of the marketplace to select the most similar plan for clients who are being crosswalked to a new plan. The selected crosswalk plan might be the same option your client may choose. Explore all available options in your client’s market before selecting a new plan.

Why Do ACA Crosswalks Exist?

The ACA was designed to protect Americans who are susceptible to being underinsured or going without health insurance because they can’t afford it. As a default, when plans are discontinued or carriers exit the marketplace, a client will be crosswalked to the most similar, lowest-cost plan to help ensure that individuals don’t go without coverage.

Crosswalks also keep individuals in the health insurance exchange. For example, a few years ago, many carriers were exiting the exchange, but were still participating in the off-exchange market. By default, clients are crosswalked to another plan on the exchange to maximize coverage benefits.

By auto-transferring clients to a new plan, individuals don’t unknowingly go without marketplace coverage. This process greatly contributes to the low uninsured rate.

By auto-transferring clients to a new plan, individuals don’t unknowingly go without marketplace coverage.

What to Watch Out for During an ACA Crosswalk

When your client is crosswalked to a new health plan, be aware that changes can occur that require attention.

Premiums

When clients are crosswalked to a new plan, it’s possible that their new premium will be higher than the premium they were paying. This happens because sometimes the closest approximation of coverage is more expensive with a new carrier or plan.

Network

Individuals may also notice that their network is different. In the worst case, some prescriptions or doctors may not be available. To receive care while being covered, your client may need to select a new physician or hospital network. Otherwise, if your client wishes to continue seeing their current provider, this care will be more expensive than before.

Subsidies

Additionally, if your clients are receiving cost-sharing reductions, or subsidies, these may still be applied to the new plan if your client’s eligibility has not changed. If your client’s income, household size, employment benefits, etc., have changed, they will have to update their eligibility application before receiving and applying subsidies. Clients who currently receive subsidies will be crosswalked to a similar Silver plan.

You can use this calculator from HealthCare.gov to estimate what your client’s cost-reductions could be. Higher subsidies are available through 2025, thanks to the Inflation Reduction Act (IRA). If your client is not currently sharing current tax return information with the exchange, your client will be crosswalked without subsidy determination.

Coverage Effective Dates

Coverage effective dates are also important to be mindful of. As for any enrollment made during the Open Enrollment Period (OEP), changes that are made before December 15 will have a January 1 effective date. For any changes made after December 15, those changes will take effect February 1.

Changes Coming for Plan Year 2024

The Department of Health and Human Services (HHS) has made some changes to crosswalks that will take effect for the 2024 Open Enrollment Period.

Subsidy Considerations

If an individual is eligible for cost-sharing reductions but is currently not using them and is enrolled in a Bronze plan, when they are crosswalked to a new plan, they will be enrolled in a Silver plan to utilize subsidies and reduce health care costs if one is available within the same network.

For clients who are not eligible for subsidies, the previous auto-enrollment process will be used. A client will be crosswalked to a plan with a similar network, same metal tier, and same product type.

Individuals are required to reconcile their subsidies when filing their annual tax return. Starting in 2024, if your client has failed to reconcile subsidies for the previous two consecutive years, their subsidies will be terminated.

Metal Tier Plan Availability

If your client is enrolled in a higher-tier plan (Silver, Gold, Platinum) that is being discontinued and there is not a plan of the same tier available with the same network, your client may be crosswalked to a new plan of a lower tier. Your client may notice differences in premiums and what costs are covered.

Health plan mapping, or crosswalks, are one patient protection embedded in the ACA designed to reduce health care costs and eliminate coverage gaps. As your clients’ trusted agent, remember to encourage them to stay on top of communications from their insurer and educate them on crosswalks to put them in charge of their health care coverage.

At Ritter, we want to support you so you can better support your clients. Become a Ritter agent today to benefit from our educational resources, exclusive carrier contracts, and dedicated sales staff that is available to answer questions and help you find the right product for your portfolio.