Enrollment Updates

Local
Today, our Certified Application Counselor was finally able enroll someone online!

The woman was able to look at different plans and compare them.

The woman was paying over $500 a month for insurance.  She selected a plan is $250/ month, and with her tax subsidy, it will end up costing her $70/ month. 

Stay tuned for more details on this story!

*As a side note, though, navigators and certified application counselors (CACs) do not have any special access or magic powers to access the Marketplace. Our CAC has been receiving many phone calls from people looking for her to get them access to the Web site.  The best they can do is sit down with you and hope it works.  If not, they can at least educate you about the law and answer any questions you may have. 

National
We just learned on a conference call that the enrollment period for January 1 coverage has been extended from December 15 now to December 23.

The enrollment period for 2015 will now take place November 15, 2014- January 15, 2015 (It was pushed back a month and extended by a week).

If you can't keep your insurance… where you stand

President Obama upset millions of Americans.  Over the past few years, he said that “If you like your health plan, you can keep it.”  This has turned out not to be true for 5% of Americans.

It appears these plans will be available at least for a little while.  

My Advice: Consider New Options

If this happened to me, I would be mad as hell.  Especially since it’s difficult to access the new plans.  I would be worried about prices and coverage.  But, I would research what I could.  In considering this scenario, I did the research anyway. 

Here’s what I’ve come up: 

-      Any plan that was created before the passage of the ACA in 2010 was “grandfathered’ into the new Marketplace. These remain. 

-      Any plan that was created or changed after 2010 that did not meet the requirements of the ACA would be cancelled at the end of 2013. 

So, yes, the President lied.  But, the plans that people want to keep are expensive and do not carry important consumer protections such as the 10 essential health care benefits.  “Individual policies have long been a problematic part of the insurance market, with higher prices than most group plans, fewer benefits and a tendency to cut people off when they get sick,” says a Washington Post article. 

I am sure with all of this debate that people will have a little longer to choose.  I am personally hopeful that the Marketplace Web site will be working by January 1^st.  I might wait to research coverage and pricing in the Marketplace and compare the information to my current plan.  After all, a plan from the Marketplace not only brings guaranteed better protections, but it also comes with a subsidy to lower the cost. 

Proposed Fixes:

1. Obama: These plans can carry on for one more year.

2. The Senate: A few plans similar to Obama’s have been proposed.  The Landrieu bill would allow for Americans on these plans to stay on them indefinitely.  The Udall bill would allow for these plans to stay around for two years. Then, they would be cancelled.

3. The House of Representatives: Americans on these plans can stay on them, and insurance companies can sell them to others who are shopping around for insurance.  This has already passed in the House and will need approval from the Senate and the President. 

Another twist to all of this: Any decision would also need approval by each state’s insurance commissioner.  

Marketplace Web Site Problems

I've mentioned the Marketplace Web site debacle quite a few times now.  I found a great infographic that goes through different steps of the online enrollment process and the problems that have seemed to accompany each of the steps. So far, only roughly 40,000 have made it through the process. 

Source: Government contractors. Ariana Cha and Lena Sun/The Washington Post. Published on October 24, 2013, 8:03 p.m.

Keep Calm Enrollment Carries On

In a recent Gallup Poll, only a small percentage of uninsured people have visited either the federal or a state-run marketplace.

Percentage who have visited a marketplace:

18% of all uninsured adults polled 

22% of uninsured adults who plan on purchasing coverage

About 1 in four uninsured adults say they plan on paying the fine.  About half say they plan on purchasing coverage. 

How I See It

With all of the news, I get worried about whether enough people will enroll in health coverage this year to really make a difference on the cost.  In taking time to think about everything rationally instead of just reacting on emotion, I am now less worried.

Enrollment has only been open for five weeks.  There are 20 more weeks to enroll.  We can break that down into four 5-week periods.  If 22% visit a marketplace and enroll during each one of these four increments, then basically everyone who said they would enroll will have enrolled by time March 31^st comes around.   

I doubt many people are trying to put up with the botched federal website.  And some of the state-run exchanges have glitches as well.  My guess is more people will visit these sites and begin enrollment in January.  The technological kinks should be worked out by then. 

People also will have had the opportunity to learn about the ACA before visiting and enrolling.  In fact, with the exchanges being so awful, many navigators and certified application counselors have taken to educating communities.  That way, when everything is properly running, people will be well prepared for how enrollment will work and for what is the best sort of option for themselves. 

I also know that our certified application counselor’s phone rings at least once an hour every day.  Today she had 20 voicemail messages left from this weekend.  People are interested.  People want insurance.  People want to be educated on what is best for them.  In fact, when Romneycare first rolled out in Massachusetts, on average, people had 18 interactions with the exchange before finally enrolling.  They were researching their options and taking time to understand how they were affected.  There was a surge in enrollment during the last two months of Romneycare enrollment.  Seven years later, 97% of people in Massachusetts are insured.  

Fear not.  Stay logical.  Get insurance.  Get and stay healthy.  

A Success Story from Pittsburgh

A Pittsburgh woman was patient in her quest for new health coverage.  Gail Roach was paying $509/ month because of her pre-existing condition (Type 2 diabetes).  After attempting to search prices on the federal Marketplace, Roach called the phone number (1-800-318-2596). The person on the other end of the line found a plan for Roach that will cost $1.11/ month. 

ACA Benefits

ACA Health Care Plan Costs: Explanation and Examples

Example Pricing: Western Pennsylvania

 

Explanation of Graphics 

As you can see, each health insurance provider listed a plan for each of the metal levels which we discussed in the previous blog post.  You may also notice a “Catastrophic” option.  This is available to adults under 30 years old.  It is a very low monthly payment compared to the metal levels, but a higher out-of-pocket expense if the person needs something extra such as an emergency room visit.   

The Catastrophic plan allows for 3 primary care visits/ year with no added cost (compared to unlimited visits with the metal level plans) and must cover the essential health benefits which we covered in the Halloween post. 

Plan Pricing is based on four factors:

Age:

Before the ACA, older people were charged on average 5 times more for health insurance than younger people.  Under the ACA, seniors (age 64 or older) cannot be charged more than 3 times the rate of a younger person’s plan (age 21-63). 

Tobacco Use:

A smoker can be charged 50% more than a non-smoker.  Why would you ever disclose whether you’re a smoker then?  You can potentially lie about this to avoid the higher cost, but if your health claims start looking like you are a smoker, you may have to deal with the ramifications.  Many insurance companies had already begun this extra penalty about 10-15 years ago.

If you don’t want to pay the extra cost and you aren’t brave enough to lie, you do have another option.  As long as you are enrolled in a smoking cessation class (you don’t even have to quit smoking), you should not have to pay a higher cost. 

Family Size:

This depends on factors such as your combined household income (the total of what each member of your family is expected to make in 2014), family members’ ages, and their smoking habits. 

Geographic Area: States are split up into different geographic regions to create smaller, competitive markets so that prices can be reasonable for each region instead of overpriced.  Pennsylvania is divided into 9 different regions.  

Side Note: Plans that were created before March 2010 and remained unchanged in the past few years are “grandfathered” into the ACA.  These plans do not have to charge according to these four factors.  Plans created after this date had to change to fit ACA criteria.  President Obama has been catching heat because of these “grandfathered” plans.

 

Subsidy

Most Americans should receive a tax subsidy with the purchase of their plans.  Any individual making less than $45, 960 and any family making less than $94, 200 is supposed to get some sort of compensation to help them pay for their plans.  You can use the Kaiser Foundation’s Subsidy Calculator to get an estimate on what you might receive. 

A Word of Caution: I am a little worried, though.  Before the Marketplace opened and plan prices were still unknown, I was able to get a subsidy estimate for a 25-year-old non-smoker who made $30,000/ year.  Now, if I enter the same information, the subsidy comes up as $0.  The calculator figures this based upon a silver level plan.   

I am hoping that there is a subsidy for the bronze level plan or that the calculator is inaccurate.  I am not sure how many more “lies” or problems with the ACA the American people will put up with.  

If you are truly curious, I suggest you call 1-800-318-2596.  I imagine someone will be able to tell you what your subsidy would be.

Metal Level Health Care Plans and How to Enroll

Types of Plans

Infographic from ConnectTheDotsUSA.com detailing metal levels for health care plans

Explanation of the Metal Level Plans

Viewing the Plans in Your Area

Pricing differs based on your geographic location and some individual factors.  Even though enrollment has been open for a month, it has been challenging even trying to view plans at this point in time. 

Enrollment opened on October 1, but the online federal Marketplace was not ready to handle the large volume of traffic to the site.  This has made it difficult to even view plans let alone enroll.  Seventeen states have state-run exchanges (Pennsylvania is not one of them).  These have been successful in getting people enrolled. 

How It Works (or lack thereof)

The federal Marketplace is set up in a way that you have to create a user profile before you can view anything.  During the first week of open enrollment, I wasn’t able to create a profile.  The week after that, I created a profile, but then I wasn’t able to confirm it and log in.  Finally, in the past week, I have been able to view plans in my area.  I am still unable to select a plan and enroll.  So, at this point, you may be able to create a username and view plans in your area fairly quickly.  Or, it may take you three weeks to get to the same point as myself. 

The government is saying that the Web site should be fully functional by the middle of December.  By this point, it may be too late to get coverage for January 1^st (you must enroll by December 15^th and pay for your first month’s premium before January 1^st).  Coverage purchased after December 15^th, can begin as soon as February 1^st.   

Other Enrollment Methods/ Access to Plans

There are other ways to learn of available plans in your area.  You can call 1-800-318-2596.  Since the Marketplace debacle, more staff has been added to call centers to help people enroll.  

Paper applications are also available.   Our Certified Application Counselor has helped a few people fill these out during our community outreach events.   

A word of caution: A couple weeks ago she mailed in a few paper applications for people to the address listed on the application.  The letters were returned today with a note saying the address could not be found.  The address was something unreal like 1001 XYZ Drive, Washington D.C.  We Googled it before mailing the applications, and Google found it as an ACA Headquarters location.  We should have followed our hunch; it’s not a real place.  I just checked the application form.  The address has been updated to what sounds like a believable place:

Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001

Recap of Enrollment Methods

Online Marketplace: If it is state run, you should be good to go.  If it is the federal exchange, you may have trouble enrolling.  For the few people I have spoken with who have had success online, they have accessed the site between 2 a.m. and 4 a.m.  You may try this if you would like.

Phone number: 1-800-318-2596

Paper application: It takes about 10 weeks from the time you mail papers in until the time you are officially enrolled.

Community Navigators/Certified Application Counselors: Currently, they are at bit of a standstill.  Unfortunately, they cannot magically access the Marketplace.  They can help you understand what you will need to enroll and answer any questions about how you may be affected by the law.

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UPDATES as of 11-5-2013:

The federal Marketplace is undergoing major repairs from 1 a.m. to 5 a.m. every night and is unavailable between these times.

The Obama Administration is now claiming the Web site should be running more smoothly by the end of this month instead of the middle of December.