Category: Health Exchange

Georgia Open Enrollment Likely To Fall Short of Previous Year

Georgia’s ACA exchange enrollment for 2018 may fall short of the current year totals. The final number of Georgians who actually started exchange coverage in 2017 was 404,000. This year 246,270 have signed up for coverage in the state’s exchange. Though the final week typically has high activity, the totals still seem to be lower than the half-million who signed up during the last open enrollment period. Nationally, 4.7 million individuals signed up for coverage during open enrollment this year, one reason for the lower numbers could be the shorter timeline to sign up for coverage. Enrollment in previous years lasted through January, however, this year goes from November 1st to December 15th. In addition, individuals shopping for coverage on healthcare.gov have seen premiums jump from the current year. Those who are affected the most are ones who do not get a subsidy to afford coverage. Although lower numbers, Georgia placed fourth again in enrollment among the 39 states that use the federally run exchange. To read more, please click here.

Thriving in the Health Insurance Marketplace

As the healthcare industry continues to evolve, the Center for Medicare and Medicaid Services (CMS) has proposed five changes for the Patient Protection and Affordable Care Act.  The proposed changes are focused on: Risk Adjustment, Network Adequacy, Out-of-Pocket Maximums, Standardized Options, and Small Business Health Opens Plan (SHOP).  The proposed changes with Risk Adjustment, CMS has suggested incorporating preventative services into the recreation of plan liability for the risk adjustment models in the 2017 benefit year; which is stated as a benefit since preventative care has shown to be rather costly.  With Network Adequacy, CMS anticipated leveraging the National Association of Insurance Commissioners (NAIC) policy deliberations so that states will select a certain number of metrics listed in the Letter to Issuers.  If they fail to do so, CMS proposed further applications to issuers for Qualified Health Plan certification..  In terms of the Out-Of-Pocket maximum, let’s say a facility is in-network for a patient’s care, but the doctor they are being seen by is not, CMS proposes that there should be a “cost-sharing” clause for non-participating providers to be counted towards the enrollees out-of-pocket maximum.  However, there is an exception if the issuer informs the enrollee ahead of time.  Out of the five proposed changes, CMS understands the out-of-pocket changes will be the most difficult to implement and execute.  Centers for Medicare and Medicaid Services also suggested that plans should be displayed for consumers to compare, based on quality and price, rather than the current cost-sharing structure.  Last but not least, CMS proposed offering a “vertical choice” in addition to their already existing “horizontal choice” presented by the Small Business Health Options Plans.  This will give qualified employees choices for all plans, and of all levels from a single issuer.  Since healthcare is constantly evolving, it might be a good idea to keep these changes in mind to start planning for the future.

 

Source URL https://www.federalregister.gov/articles/2015/12/02/2015-29884/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2017

 

New Federal Standards For Marketplace Plans May Reduce Out-Of-Pocket Spending

Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found.

The government wants to create six plan options at the bronze, silver and gold metal levels, each with standard deductibles, maximum out-of-pocket spending limits and copayments or coinsurance for various services. In addition, primary care and specialist doctor visits and prescription drugs would not be subject to the deductible in the standard silver- and gold-level plans. Consumers in those plans would generally make a flat copayment for those services from the beginning, such as $30 for a primary care visit, instead of owing the entire amount until they meet their deductible for the year.

The change is part of the government’s proposed regulation that sets out the benefit standards for plans sold on the health insurance marketplaces in 2017.

Because insurers wouldn’t be required to offer standardized plans under the government’s proposal, it’s unclear whether the new plans would be widely available or if they would carry significantly higher premiums than other marketplace offerings.

The change could benefit people who have few health care expenses as well as those with pricey medical conditions who usually meet their annual out-of-pocket spending limit, said Caroline Pearson, a senior vice president at Avalere.

With a typical silver plan deductible of nearly $3,000 this year, a relatively healthy person may pay hundreds of dollars monthly in premiums, yet still owe the entire bill for most medical services he receives during the year, except for preventive care, which is covered for free.

If the deductible doesn’t apply to some services, “people feel like they’re getting a benefit from their insurance,” Pearson said.
On the other hand, people with chronic conditions who owe hefty annual bills for drugs or other treatment wouldn’t have to pony up the entire out-of-pocket maximum amount in the first month or two of the year. Standard model plans would spread out their spending, Pearson said.

This year, two-thirds of silver plans sold on the marketplaces covered primary care visits before the deductible is met, similar to the proposed standard plans, the Avalere analysis found. But for other services, coverage before this point was much less routine. Only a third of silver plans covered specialist visits before the deductible was reached, while the cost of generic drugs was subject to the deductible in half of plans, and three-quarters of plans required enrollees to pay off their deductible before the plan paid for specialty drugs.

Silver plans are the most popular plans on the marketplace.

“We oppose this type of standardized benefit,” said Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. “If consumers only see a one-size-fits-all product, how is that providing them with the tailored coverage they want and need?”

The final regulation is expected within the next month, Pearson said.

Source: Kaiser Health News

Non-Medicaid Expansion States Experiences Similar to Georgia

Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States

As of Spring 2015, states had completed the second open enrollment period for the new Health Insurance Marketplaces established by the Affordable Care Act (ACA) and most of the 30 states that have adopted the Medicaid expansion to low-income adults were well into their second year of implementation. Two years into implementation, interest remains high in understanding enrollment under the coverage expansions and the extent to which enrollment problems that plagued the initial open enrollment period have been resolved. A range of other questions also have emerged, including how Marketplaces are evolving and impacting consumer choices, the extent to which State-based Marketplaces (SBMs) have achieved financial stability, whether newly insured individuals are accessing care, and what the costs of care have been for Medicaid expansion adults. This brief provides insight into these questions through an on-the-ground view of ACA implementation in five states that identifies areas of progress as well as issues to be addressed. It is based on 40 in-person interviews conducted with a range of stakeholders during April and May 2015 in three states (Colorado, Kentucky, and Washington) that have a SBM and adopted the Medicaid expansion and two states (Utah and Virginia) that rely on the Federally-facilitated Marketplace (FFM) for enrollment of individuals into qualified health plans (QHPs) and have not adopted the Medicaid expansion to date.

Key findings from stakeholders in the study states are highlighted on Table 1. In sum, they show that, as of the second year, most major enrollment systems issues had been resolved. The states that expanded Medicaid continued to experience enrollment growth, and Marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a key enrollment challenge. In all five states, broad efforts are underway to increase health insurance and health care literacy among newly insured individuals. Per enrollee costs of care for expansion enrollees have been lower than anticipated in the three states that expanded Medicaid. Expansion enrollees generally are able to access needed care, although there are access challenges for some services. Access to care for individuals enrolled in QHPs varies based on their choice of plan.

Looking ahead, the states are focused on a range of priorities, including continued improvements to enrollment systems and efforts to enhance access to care and care coordination. Moreover, in Colorado and Washington, there is significant pressure on the Marketplaces to achieve financial sustainability; in Utah and Virginia, debate around the Medicaid expansion and the outcome of the King v. Burwell Supreme Court case remain the most significant issues; and, in Kentucky, the upcoming gubernatorial election could have significant implications for implementation given the opposition to the ACA among potential candidates.

Table 1: Key Findings on the Second Year of ACA Implementation from Stakeholders in Five States:
Colorado, Kentucky, Utah, Virginia, and Washington
Enrollment
  • In four of the states, most major enrollment system issues had been resolved (KY, UT, WA, and VA).
  • There was continued enrollment growth in the Medicaid expansion states (CO, KY, WA), with some slowing in the pace of growth (CO, KY) and some increases in children as a share of new enrollees (CO, WA).
  • Marketplace enrollment goals were met or surpassed in four of the five states (CO, KY, UT, and VA). In KY, the balance between new QHP and Medicaid enrollments was beginning to even out with an increase in the share of new enrollments among QHPs.
  • In all five states, many consumers successfully renewed QHP coverage, with about half of re-enrollees shopping for new plans. However, some renewal challenges remain, including the need for improved consumer outreach and education about renewal.
Marketplace Plans and Premiums
  • Three states saw new insurers enter the market (KY, VA, and WA), while two had high continuity among plan offerings (CO and UT).
  • Four states (CO, KY, UT, and VA) experienced changes in the second lowest cost silver, or benchmark plan, which affected the level of premium tax credits available for eligible consumers.
  • In two states (VA and KY), low-cost plans with a large market share adopted large premium increases, leaving consumers to renew their plan with a large increase or switch plans.
  • Despite attempts to educate consumers about total-out-pocket costs, many selected plans based on the lowest premium, leaving them with high deductibles and cost sharing. Some individuals who purchased bronze plans did not maintain their coverage due to high out-of-pocket costs.
  • Premiums remain unaffordable for some consumers even with subsidies.
Outreach
  • Messaging moved away from raising awareness to personal testimonials and emphasis on the importance and value of coverage.
  • Both mass marketing and local level outreach and enrollment assistance remained important, with some shifting away from mass marketing to community efforts.
  • As the group of uninsured individuals narrows, targeted strategies to reach specific groups have become increasingly important.
Access, Utilization, and Costs
  • Per enrollee costs of care for Medicaid expansion adults have been lower than anticipated in the three states that expanded Medicaid (CO, KY, and WA).
  • In the Medicaid expansion states, enrollees are generally able to access needed care, although there are access challenges for certain services and providers.
  • Access to care for individuals enrolled in QHPs varies based on their choice of plan. Some individuals who selected lower cost plans with limited networks experienced challenges accessing care, although some of these challenges have moderated over time.
  • In all five states, broad efforts are underway at multiple levels to increase health insurance and health care literacy among newly insured individuals.
  • In the Medicaid expansion states (CO, KY, and WA), clinics that historically served uninsured populations reported an increase in their share of patients with coverage, but a significant share of their patients still remains uninsured, leaving other funding streams important.
  • Clinics and hospitals in the non-expansion states (UT and VA) identified a range of financial challenges due to the coverage gap and reductions in funding.
Priorities Looking Ahead
  • All five states plan to continue to refine and enhance their enrollment systems.
  • Some stakeholders indicated that they anticipate more limited funding for marketing and outreach next year.
  • Stakeholders in all five states emphasized the need for continued work to increase individuals’ health insurance and health care literacy. All five states also are engaged in a range of delivery system reforms and care coordination initiatives.
  • In CO and WA, there is significant pressure on the Marketplaces to achieve financial sustainability.
  • In UT and VA, debate around adopting the Medicaid expansion remains the most significant issue as well as uncertainties related to the outcome of the King v. Burwell Supreme Court case.
  • In KY, stakeholders emphasized that the upcoming gubernatorial election could have significant implications, given opposition to the ACA among potential candidates.

In sum, these findings show that, as of the second year of ACA implementation, most major enrollment system issues had been resolved. The states that expanded Medicaid continued to experience enrollment growth, and Marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a key enrollment challenge. In all five states, broad efforts are underway to increase health insurance and health care literacy among newly insured individuals. Overall, costs of care for Medicaid expansion enrollees have been lower than anticipated in the three states that expanded Medicaid. Expansion enrollees generally are able to access needed care, although there are access challenges for some services. Access to care for individuals enrolled in QHPs varies based on their choice of plan.

Looking ahead, the states are focused on a range of priorities, including continued improvements to enrollment systems and efforts to enhance access to care and increase care coordination. Moreover, in Colorado and Washington, there is significant pressure on the Marketplaces to achieve financial sustainability; in Utah and Virginia, debate around the Medicaid expansion and the outcome of the King v. Burwell Supreme Court case remain the most significant issues; and, in Kentucky, the upcoming gubernatorial election could have significant implications for implementation given the opposition to the ACA among potential candidates.

The authors gratefully acknowledge Michael Perry, Sean Dryden, and Naomi Mulligan Kolb with Perry Undem Research/Communication for their work managing the fieldwork logistics, conducting the interviews, and assisting in identifying key themes for this project. They also extend their deep appreciation to all the participants for sharing their time and perspectives to inform this project.

 

Thank you to the authors: Samantha Artiga, Jennifer Tolbert, and Robin Rudowitz

For More Information: Please Visit Kaiser Family Foundation 

Open Enrollment Week 7: December 27, 2014 – January 2, 2015

Posted January 7, 2015

Since Open Enrollment began on November 15, nearly 6.6 million consumers selected a plan or were automatically re-enrolled in the Federally Facilitated Marketplace (FFM). The Week 7 snapshot includes the New Year’s holiday; consumers continued to shop and select the plan that best meets their financial or health needs.

“Thanks to the Affordable Care Act, nearly 6.6 million Americans have access to quality, affordable health coverage for 2015 through the Federally Facilitated Health Insurance Marketplace. As we turn to the New Year, our focus is on helping every individual who is interested in quality, affordable health insurance to understand their options and to get covered,” HHS Secretary Sylvia Burwell said. “For coverage starting on February 1, it is important for people to sign-up now ahead of the January 15 deadline.”

HHS produces more detailed reports that look at plan selection across the Federally Facilitated Marketplace and State-Based Marketplaces on a monthly basis. The first Open Enrollment monthly report was released on December 30. Weekly snapshots do not include the consumers who visited, called, shopped or selected a plan through a State-Based Marketplace.

The Open Enrollment snapshots for the Federally Facilitated Marketplace provide point-in-time estimates for weekly data. These are preliminary numbers and could fluctuate based on consumers changing or canceling plans or having a change in status such as new job or marriage. The snapshots also include totals from the beginning of the 2015 Open Enrollment period, which started November 15, 2014. Note that data revisions may mean that the weekly totals do not sum to the cumulative numbers.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot Week 7
Dec 27 – Jan 2
Cumulative
Nov 15 – Jan 2
Plan Selections 102,896 6,593,388
Applications Submitted 246,543 8,436,130
Call Center Volume 681,264 7,412,617
Average Call Center Wait Time 1 minute 27 seconds 7 minutes 56 seconds
Calls with Spanish Speaking Representative 57,704 593,209*
Average Wait for Spanish Speaking Rep 8 seconds 27 seconds
HealthCare.gov Users 1,954,996 16,449,792
CuidadoDeSalud.gov Users 51,302 571,220
Window Shopping HealthCare.gov Users 491,302 5,749,154
Window Shopping CuidadoDeSalud.gov Users 7,494 121,096

Consumers can shop and sign up for affordable health coverage that fits their health and financial needs any time between now and February 15, 2015. If consumers who were automatically re-enrolled decide in the coming weeks that a better plan exists for their family, they can make that change at any time before the end of Open Enrollment on February 15.

Glossary

Plan Selections:  The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected the plan that best fits their needs. In addition, totals now include those consumers who were automatically re-enrolled into their current plan or a plan with similar benefits. As noted previously, these numbers fluctuate based on consumers changing or canceling plans or having a change in status such as a new job or marriage; changes for the entire open enrollment period are reflected in the most recent weekly and cumulative metrics.

To have their coverage effectuated, consumers need to pay their first month’s health plan premium. This release does not include effectuated enrollment.

All references to the Marketplace in this report refer to 35 states that are states that used the HealthCare.gov platform in both 2014 and 2015 and Oregon and Nevada, which are new to the FFM platform in 2015. Those states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

Applications Submitted:  A consumer who has completed an application and submitted it or who through the automatic enrollment process had an application submitted to the Federally Facilitated Marketplace. If determined eligible for Marketplace coverage, the consumer still needs to pick a health plan that best fits their financial and health needs and pay their premium to get covered. Because families can submit a single application, this figure tallies each person covered by an application. The weekly and cumulative metrics total the number of people who have submitted an application.

Call Center Volume:  The total number of calls received by the Federally-Facilitated Marketplace call center over the course of a week or from the start of Open Enrollment.

Calls with Spanish Speaking Representative:  The total number of calls received by the call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the call center volume.

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

HealthCare.gov or CuidadodeSalud.gov Users: The user metric totals how many unique users viewed or interacted with either HealthCare.gov or CuidadodeSalud.gov over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Note: in reporting from the last open enrollment period “users” was reported as “unique visitors”.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: The user metric totals how many unique users interacted with the window-shopping tool over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadodeSalud.gov user total. Note: in reporting from the last open enrollment period “users” was reported as “unique visitors”.

* The weekly total for calls with a Spanish speaking representative for December 20-26 is 38,131, not 28,131 as it was listed in the Week 6 snapshot. Cumulative totals have been adjusted to note the 10,000 additional calls received.

Source URL http://www.hhs.gov/healthcare/facts/blog/2015/01/open-enrollment-week-seven.html#ftnref1

Open Enrollment Week 3: November 29 – December 5, 2014

Posted December 10, 2014 by HHS.gov

Consumers continued to reach out to in-person assisters or call center representative at 1-800-318-2596 and visited HealthCare.gov or CuidadodeSalud.gov to learn about their plan options, to find out what financial help is available, or to select the plan that best meets their financial and health needs during the second week of Open Enrollment.

“Open enrollment’s momentum is building, and I’ve seen that firsthand as I traveled the country and talked to people – from Florida to New Jersey to Pennsylvania to Texas,” HHS Secretary Sylvia Burwell said. “With less than a week left to sign up for coverage that starts January 1, we’re encouraging new and returning consumers to visit HealthCare.gov, call the call center or get in touch with a local assister by December 15. With more issuers this year, it pays to shop for the best deal.”

More than 1.3 million consumers have selected plans since the beginning of Open Enrollment. As we approach the December 15 deadline for coverage that startsJanuary 1, 2015, interest has increased – last week’s plan selections were 33 percent higher than the first week, and double the number of plan selections during the week of Thanksgiving.

Each month, HHS will produce a report that provides a detailed look at plan selection across the Federally Facilitated Marketplace and State-Based Marketplaces. In addition, CMS is releasing weekly snapshots of preliminary data. These snapshots do not include the consumers who visited, called, shopped or selected a plan through a State-Based Marketplace.

The weekly Open Enrollment snapshots for the Federally Facilitated Marketplace (FFM) provide point-in-time estimates for weekly data. These are preliminary numbers and could fluctuate based on consumers changing or canceling plans or having a change in status such as new job or marriage. The snapshots also include totals from the beginning of Open Enrollment. Note that data revisions may mean that the weekly totals do not sum to the cumulative numbers.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot Week 3
Nov 29 – Dec 5
Cumulative
Nov 15 – Dec 5
Plan Selections 618,548 1,383,683
New consumers 48 percent 48 percent
Consumers renewing coverage 52 percent 52 percent
Applications Submitted 974,018 2,526,574
Call Center Volume 982,022 2,536,267
Average Call Center Wait Time 3 minutes 11 seconds 2 minutes 31 seconds
Calls with Spanish Speaking Representative 87,534 236,588
Average Wait for Spanish Speaking Rep 12 seconds 9 seconds
HealthCare.gov Users 3,023,301 7,942,195
CuidadoDeSalud.gov Users 98,336 244,016
Window Shopping HealthCare.gov Users 1,072,169 3,061,540
Window Shopping CuidadoDeSalud.gov Users 19,675 61,068

Consumers can shop and sign up for affordable health coverage that fits their health and financial needs any time between now and February 15, 2015. For coverage to start on January 1, 2015, consumers must enroll in a plan by December 15, 2014. Current consumers enrolled in coverage through the Marketplace for 2014 should come back, update their application and shop by December 15 because there could be a plan that better meets their needs and they could qualify for more financial help. Most consumers who do not take action before the deadline will be automatically enrolled by their insurance company into their current plan or a plan with similar benefits.

Glossary

Plan Selections: The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected the plan that best fits their needs. As noted previously, these numbers fluctuate based on consumers changing or canceling plans or having a change in status such as new job or marriage; changes for the entire open enrollment period are reflected in the most recent weekly and cumulative metrics.

To have their coverage effectuated, consumers need to pay their first month’s health plan premium. This release does not include effectuated enrollment.

All references to the Marketplace in this report refer to 35 states that are states that used the HealthCare.gov platform in both 2014 and 2015 and Oregon and Nevada, which are new to the FFM platform in 2015. Those states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

New Consumers: New consumers are those consumers who are selecting a plan for the first time or whose plan selection in 2014 was terminated, because, for example, they failed to pay their premium or gained coverage through employer-sponsored insurance. In addition, because Oregon and Nevada consumers now use the Federally Facilitated Marketplace platform, they are considered new enrollments.

Consumers Renewing Coverage: Consumers with 2014 effectuated enrollment who have actively submitted a 2015 application and selected a plan or, after December 15, have been auto-renewed.

Applications Submitted: A consumer who has completed an application and submitted it. If determined eligible for Marketplace coverage, the consumer still needs to pick a health plan that best fits their financial and health needs and pay their premium to get covered. Because families can submit a single application, this figure tallies each person covered by an application. The weekly and cumulative metrics total the number of people who have submitted an application.

Call Center Volume: The total number of calls received by the Federally-Facilitated Marketplace call center over the course of a week or from the start of Open Enrollment.

Calls with Spanish Speaking Representative: The total number of calls received by the call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the call center volume.

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

HealthCare.gov or CuidadodeSalud.gov Users: The user metric totals how many unique users viewed or interacted with either HealthCare.gov orCuidadodeSalud.gov over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Note: in reporting from the last open enrollment period “users” was reported as “unique visitors”.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: The user metric totals how many unique users interacted with the window-shopping tool over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov orCuidadodeSalud.gov user total. Note: in reporting from the last open enrollment period “users” was reported as “unique visitors”.

Source URL: http://www.hhs.gov/healthcare/facts/blog/2014/12/open-enrollment-week-three.html

 

With 1.5 Million Sign-ups so far, Obamacare Enrollment is Brisk

Article By:

Phil Galewich

With less than a week until the deadline to buy individual health insurance that begins Jan. 1, experts say sign-ups are on course to hit or exceed the Obama administration’s projection of about 9 million enrollees in 2015.

Several weeks into the second year of the Affordable Care Act’s insurance exchanges, about 1.5 million people have enrolled in coverage, according to data from state and federal exchanges.

As of Dec. 5, almost 1.4 million had enrolled through the federal insurance exchange, which serves 37 states, the Centers for Medicare & Medicaid Services reported Wednesday. Another 183,000 chose plans through state exchanges, including nearly 49,000 in California, according to a Kaiser Health News analysis of state exchange data.  Enrollment figures were not available for exchanges in New York, Idaho and Rhode Island.

“Exchange enrollment is far ahead of 2014’s pace due to improved technology performance,” said Caroline Pearson, vice president of Avalere Health, a consulting firm.

She said sign-ups are on track to “far exceed” the Obama administration’s 9 million projection, made just before open enrollment began in November. If enrollment continues at this pace, she said, the federal and state exchanges should enroll between 4 and 5 million new participants, she said. That’s in addition to 6.7 million who got coverage for 2014, many of whom are expected to re-enroll for 2015.

Enrollment in 2014 plans reached nearly 7 million despite the disastrous rollout of the federal and several state exchanges, which made it difficult if not impossible to sign up in the early months.

This KHN story can be republished for free (details).

Sign-ups for 2015 began Nov. 15 and continue through Feb. 15. However, those who want coverage in January must enroll by Monday.

Some Republicans have argued that enrollment would suffer in the law’s second year because people would be unhappy with their coverage and prices would skyrocket. So far, that does not appear to be happening.

Several state insurance exchanges reporting data appear to be ahead of where they were several weeks into open enrollment last year, including Massachusetts, Maryland and Vermont.

It is not known how many of the enrollees in some state exchanges are new to the market. But on the federal exchange about 48 percent of the people selecting plans are new, while 52 percent had coverage in the marketplace this year, according to CMS. California officials said it was too early to tell how many of the 1.1 million current enrollees have returned for 2015. In most states, consumers will be automatically re-enrolled in the same plan or one like it if they have not selected a plan by Dec. 15. They can switch before Feb. 15.

“The pace of enrollment is very strong,” Peter Lee, executive director of Covered California, told reporters Wednesday. The state is already on its way to meeting its goal of 750,000 new enrollees this year, Lee said.

He said he expected the momentum to continue, with more than 40 enrollment events planned through Dec. 15.

On the federal exchange, tens of thousands of people have started accounts but not yet selected a plan.

Charles Gaba, a blogger based in Bloomfield Hills, Mich. who accurately forecast 2014 enrollment, predicts that about 12 million Americans will enroll in exchange coverage in 2015.

The Congressional Budget Office had predicted about 13 million sign-ups for 2015, but in November, administration officials estimated about 9 million, in part because fewer employers than expected were dropping coverage and sending their workers to the exchanges. That includes those who re-enroll in coverage as well as new sign-ups.

Similar to last year, the biggest surge in enrollment is expected immediately before the Dec. 15 deadline to have coverage by Jan. 1 and then, right before Feb. 15, which is the final deadline to have coverage in 2015, Gaba said.

Dan Schuyler, senior director of exchange technology at consulting firm Leavitt Partners, said state exchanges are performing much better than they did last year, though there have been minor glitches.

Two state exchanges—Nevada and Oregon, switched to the federal healthcare.gov portal after abandoning their own failed software. Maryland, meanwhile, took software from the Connecticut exchange.

“It seems like state exchanges have turned the corner this year,” Schuyler said.

Jon Kingsdale, who oversaw the Massachusetts health insurance exchange from 2006 to 2010 and is a managing director of the Wakely Consulting Group, said customer call centers are also working better with better-trained staff.

One big challenge facing the exchanges, he said, is how well they “hand off” enrollments to health plans which was a problem in some states last year.

The exchanges also have to make sure automatic re-enrollment works later this month, Schuyler said. Many consumers who are automatically re-enrolled may be shocked to learn their plans have raised rates or changed their benefits, he said.

State and federal officials also have to keep reaching out to consumers. California’s insurance exchange has partnered with hospitals and medical groups to get the word out about the availability of coverage. The agency also stepped up advertisements, including a bilingual campaign featuring people who enrolled last year.

There has also been strong interest in Medi-Cal – California’s version of Medicaid, the state-federal program for low-income people. About 160,000 have applied and three-quarters were enrolled immediately, while the others are still going through the process, said Toby Douglas, director of the state’s Department of Health Care Services.  “It is clear that Californians’ desire for health coverage remains really strong,” he said.

 

Source URL

http://kaiserhealthnews.org/news/with-1-5-million-sign-ups-so-far-obamacare-enrollment-is-brisk/

Doctors complain they will be paid less by health exchange plans

Article reposted from NBC News:

Written by:  Roni Caryn Rabin, Kaiser Health News

Many doctors are disturbed they will be paid less — often a lot less — to care for the millions of patients projected to buy coverage through the health law’s new Health Exchange marketplaces.

Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C.

If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

But many primary care doctors say they barely have time to take care of the patients they have now.

The conflict sheds light on the often murky world of insurance contracts in which physicians don’t always know which plans they’re listed in or how much they’re being paid to treat patients in a particular plan. As a result, some doctors are just learning about the lower pay rates in some plans sold in the online markets, or exchanges

“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” said Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

Blues: No desire ‘to gouge’ docs A senior executive at Blue Cross Blue Shield Association said some of its 37 member organizations – each of which operate independently and offer a variety of plans – are offering lower rates to physicians in smaller exchange plan networks.

But, she said, plans know that a good network of providers is essential or customers “will go someplace else,” and they are enlisting sufficient numbers of doctors.

“We’re not motivated to gouge the doctor,” said Kim Holland, Blue Cross Blue Shield Association executive director for state affairs. “We depend on good relationships with quality physicians. … I can’t imagine any product we offer is going to have a physician rate that would discourage them from seeing a patient.”

But some physicians see things differently. Contracts between insurers and doctors vary with some allowing insurers to adjust rates unilaterally or to assign a doctor to multiple plans.

“I’ve participated with Oxford since 1985. They don’t send me a contract every year to sign. They don’t send me the rates. You don’t know the rates,” said Dr. Paul Orloff, a physician who is president of the New York County Medical Society. “It’s the only game in town so you sign. They have a right to unilaterally change the rates at any time during the contract.”

The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Some experts minimized the impact of lower pay rates on enrollees.

People “may experience wait times to get in, but that is not unique to people in exchange plans,” said Sara Rosenbaum, a professor of health law and policy at George Washington University,

Rosenbaum said she was not overly concerned about physicians’ compensation. “I don’t mean to suggest that physicians don’t deserve to do well,” she said. “But physicians are very well-compensated people, no matter what.”

Confusion about rates, provider lists Many doctors say they have not decided if they will participate in the new plans – in some cases, even when an insurer is including them in their provider list.

A survey by The Medical Society of the State of New York found that 40 percent of more than 400 physicians who had responded so far said they chose not to participate in a health insurer’s exchange plan, and one-third said they did not know whether they were participating or not.

“I have patients calling my office and saying … ‘Oh good, I see you’re in the network,’” said Patricia McLaughlin, an ophthalmologist in New York City. But, she added, “I’m not sure I am or am not at this point.”

Some insurers have contractual arrangements with physicians that allow them to automatically include doctors in a new plan, unless the physician requests to opt out in writing, according to Mike Scribner, CEO of Strategic Healthcare Partners, a health care consulting firm based in Savannah, Ga., that represents about 700 physicians and 30 managed care hospitals in the state.

Dr. Richard E. Thorp, an internist who is president of the California Medical Association and heads a physician-owned multi-specialty primary care group in Paradise, Calif., said one plan sold on that exchange “was going to pay us significantly less for doing that business. And we are already very busy.”

His practice delayed signing a contract, he said. But about three weeks ago, the group was informed the insurer was short on physicians and was therefore including doctors from other plans at their old rates.  So his practice was included at the higher rate.

Advocates say that consumers should be wary of information in plan directories and confirm participation with their doctors.

The California Medical Association is so concerned about errors that it has asked Covered California, the state’s insurance marketplace, to remove a search function that lets buyers plug in the names of physicians and get a list of all the plans that they participate in, said Lisa Folberg, vice president for medical and regulatory policy for the California Medical Association.

“There shouldn’t be any ambiguity about who’s in the network,” said Lynn Quincy, a senior analyst with Consumers Union, the policy division of Consumer Reports.

“These consumers are buying a product, one dimension of which is to provide a network–a very important dimension.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

BCBSGA Healthcare Exchange Products

There is ongoing confusion over the physician panels that BCBSGA utilized for their healthcare exchange products.  In an effort to address this confusion, BCBSGA has just published updated directories for the new healthcare products that they will be marketing effective January 1, 2014:

 http://www.bcbsga.com/wps/portal/chpfooter?content_path=shared/noapplication/f0/s0/t0/pw_e206385.htm

This link includes directories for the “Pathway” and “Pathway X” product lines; “Pathway X” products will be sold on the Healthcare Exchange while “Pathway” products will be sold on the commercial marketplace.

BCBSGA confirmed to the Medical Association of Georgia (MAG) that these provider directories are completely accurate and they have removed all physicians who submitted prior opt out notifications to BCBSGA. Therefore, SHP encourages all our clients to view each directory in the above link to determine if your physicians are listed as participating providers.  If your physicians are listed and you previously submitted an opt-out notification to BCBSGA, please contact BCBSGA immediately to inquire about your continued listing in these directories. We would also greatly appreciate it if you could let us know as well.

In addition, the Medical Association of Georgia (MAG) recently met with BCBSGA to obtain clarification about BCBSGA’s new product lines and BCBSGA confirmed that the rate schedules for the Pathway and Pathway X product lines would match the rates from the Direct Access amendments that were disseminated to providers this past spring. If you are included in the Pathway/Pathway X directories, it is critical to understand your Pathway/Pathway X rates as these product lines are not just limited to the healthcare exchange but will be marketed to commercial beneficiaries as well.

Finally, it is anticipated that BCBSGA will be sending HMO plan rate amendments to providers within the next month.  We are significantly concerned about the combined impact from the introduction of the Exchange plans as well as reimbursement adjustments for your BCBSGA commercial product lines; particularly as the number of BCBSGA commercial beneficiaries will be growing significantly effective January 1, 2014 when the State Health Benefit Plan lives transition into the BCBSGA HMO product lines.