Archive | Health Care Bill Impact on Business

Obamacare may get sick if young Americans don’t sign up

Now that more than 2 million people have signed up for private insurance plans created by President Barack Obama’s healthcare law, a crucial next check-up for the new marketplace will be to see how old customers are.

  • Early data from a handful of state exchanges shows the administration needs more young adults to sign up in the next three months to help offset costs from older enrollees and prevent insurers from raising their rates.

Critics of Obama’s Affordable Care Act say the market won’t attract enough young people to keep it financially viable, putting more pressure on government funds to compensate for any insurer losses.

  • Data from seven states and the District of Columbia, which are running their own marketplaces, show that of more than 200,000 enrollees, nearly 22 percent are 18 to 34 years old, according to a Reuters analysis.

The administration had hoped that over 38 percent, or 2.7 million, of all enrollees in 2014 would be 18 to 35 years old, based on a Congressional Budget Office estimate that 7 million people would sign up by the end of March.

“The whole insurance relationship is counting on them signing up,” said Dale Yamamoto, an independent healthcare actuarial consultant. “Otherwise rates will have to increase.”

The picture from the initial state data is likely to change, since it mostly includes people who enrolled only through November, before a year-end surge of sign-ups for people wanting coverage effective Jan 1. Many experts speculate the early enrollees were more likely to be in urgent need of coverage, and therefore more likely to be older or sicker.

A recent survey by The Commonwealth Fund, a healthcare research foundation, found that 41 percent of those who had shopped at the various state marketplaces by the end of December were ages 19 to 34, up from 32 percent from an October survey.

One marketplace with current data, the District of Columbia, said on Friday that of the 3,646 enrollees in private plans through Thursday, about 44 percent are young adults.

A FACTOR OF PRICE

  • The Affordable Care Act, popularly known as Obamacare, prevents insurers from charging people more if they have a health problem. Age is one of the few factors that can affect the price, with insurers allowed to charge up to three times more for a 64-year-old than someone in their early 20s.

But the healthcare costs for a 64-year-old on average are nearly five times as much as a 21-year-old, according to a study of claims from three large insurers Yamamoto conducted for the Society of Actuaries.

“The more that the marketplace is able to attract a broad mix of enrollees including the young and healthy … the more that costs will be sustainable and premiums will be more affordable,” said Robert Zirkelbach, spokesman for America’s Health Insurance plans, a trade group for insurers.

Other factors may be as crucial, if not more, in determining the stability of the new market, including the health status of enrollees, regardless of their age, and how that lines up with what individual insurers had projected. But those details will only become clearer later in the year based on the medical claims filed by the newly insured, making age the best early proxy about whether the market is sustainable.

The Centers for Medicare and Medicaid Services, which oversees the marketplace for 36 states, has yet to provide any demographic data about enrollees. CMS is expected to release an enrollment report later this month.

Data may come sooner from insurers as they discuss their recent financial performance with investors in the next few weeks. Humana Inc said on Thursday that the mix of enrollment in its marketplace plans were likely to be “more adverse than previously expected.

  • But healthcare experts say insurers need a better mix of enrollees than seen in the early data.

“If a quarter or more of the enrollees are young adults, I would think that’s an encouraging sign, particularly for the first half of the open enrollment period,” said Larry Levitt, senior vice president at the Kaiser Family Foundation healthcare think-tank.

By the end of March, “if it’s lower than that, I think there would be some cause for concern,” Levitt said.

Levitt and colleagues at Kaiser analyzed a scenario that they deemed “worst case” in which young adults represented 25 percent of enrollees. They found that costs then would be about 2.4 percent higher, but insurers would retain a very slim profit margin. As a result, the Kaiser authors projected the companies would raise premiums by a commensurate amount, but not enough to destabilize the market.

Using the same data as Kaiser but different assumptions, Seth Chandler, a law professor at the University of Houston who specializes in insurance, said costs would be 3.5 percent higher, should only 25 percent of enrollees be young adults.

  • “If we see fewer than 30 percent of the enrollees being in that 18-to-34 age bracket, that’s a warning sign that there are problems,” Chandler said. “If the demographics come in poorly, insurers are going to lose money.”

Chandler is a skeptic of the healthcare law and writes a blog called “ACA Death Spiral.” Such a spiral is thought to occur if insurers facing higher costs raise premiums, so only very sick people buy coverage, leading to even higher premiums with the pattern continuing until the insurance market either disappears or shrinks to the point that it is not sustainable.

*Modified from a Reuters article

0

Insurance Companies Deserve Obamacare

The latest attempt by the Obama administration to avoid the consequences of its inept implementation of the Affordable Care Act has been to issue yet another of its surprise edicts. This new Health and Human Services regulation, which was announced Thursday night, “significantly relaxed the rules of the federal health-care law for millions of consumers whose individual insurance policies have been canceled, saying they can buy bare-bones plans or entirely avoid a requirement that most Americans have health coverage.”

This last minute movement of the goalpost comes on the heels of another HHS rule change, issued a week ago, that essentially forces insurers to provide retroactive, discounted coverage to the many Americans who are about to lose their insurance plans because of Obamacare.

  • Insurers are not amused. The statement released by the President of America’s Health Insurance Plans was typical: “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers.”

 The White House and HHS claim, however, that this is really no big deal. They assert that the rule change will only affect a few hundred thousand people.

The negative effects of the rule changes will be felt mostly by insurers, and the administration knows that few tears will be shed for the plight of Blue Cross Blue Shield or Kaiser Permanente. The electorate regards the industry with a jaundiced eye.

  • The insurers did nothing to improve their public image by entering into a Faustian bargain with the White House whereby they agreed to promote Obamacare in return for potentially enormous profits from millions of new customers who will be herded to them by its exchanges.

In 2012, the health insurers kept their part of the deal by spending $216 million to pimp Obamacare, but the president and his accomplices began double-crossing them as soon as it became politically expedient. Before the latest two imperial decrees, for example, the administration postponed implementation of the employer mandate for a year and delayed the beginning of the 2015 enrollment period until after the upcoming midterms.

  • These rule changes will cost health insurers millions in expected premiums.

Yet even after these betrayals, the representatives of the insurance industry were actually surprised by the latest arbitrary edicts. After last week’s rule change, the National Association of Insurance Commissioners issued the following statement: “This decision continues different rules for different policies and threatens to undermine the new market, and may lead to higher premiums and market disruptions in 2014 and beyond.” Officials from America’s Health Insurance Plans issued a similarly querulous statement.

  • But the nation’s insurance executives still think they have a deal. They are still betting big money that Obamacare will turn into a cash cow. The Wall Street Journal reports that insurers will spend $500 million promoting the Affordable Care Act in 2014. In fact, one company plans a huge ad buy before the end of this year: “WellPoint…said it expects to spend up to $100 million by the end of this year on TV, social media and print ads targeting mostly young and healthy people.”

This Wellpoint pitch is, if possible, even more naïve than the expectation that the government will stop changing the rules in the middle of the game.

  • While it may be true that the public school system has steadily eroded the critical thinking skills of the nation’s young adults, they are still not dumb enough to pay exorbitant premiums for health coverage they neither want nor need.

This is particularly true if a viable alternative is available. And there is, in fact, a better choice. The penalty for not carrying insurance is only $95.

  • And, sure enough, they are not signing up in large enough numbers to prevent Obamacare from collapsing under its own weight. As the Atlantic reports, “18 to 34 year olds have only made up about 20 percent of enrollees in states we have data for.

That’s half of what they need to be for the system to work. Otherwise, premiums could rise, which could make more healthy people forgo insurance—and premiums could rise again.” This is the “insurance death spiral” that arises when low-risk individuals choose to remain uninsured while high-risk individuals enroll in droves.

  • Obamacare’s perverse incentives have rendered this death spiral virtually inevitable. Thus, the health insurance companies will suffer the same fate as all of Obama’s other collaborators in the fraudulent cause of health care “reform.” Just as the quisling strategies of the American Medical Association and Big Pharma have already hurt physicians and stunted medical innovation, the role health insurance companies have played in perpetrating Obamacare will inflict serious damage on their own industry.

It is not a coincidence that many of the people who promoted the “Affordable Care Act” are now claiming that its travails are rooted in the decision to allow insurers to play a role. These people will increasingly claim that a single payer system is the only cure for Obamacare’s ills. And they will advocate the eradication of insurance companies from American health care. That would be condign punishment indeed.

Modified from a Spectator.org article

0

Will Insurers Ever Say Enough’s Enough To Obamacare?

How can anyone run a business this way?

Modified from an article by Greg Scandlen, December 27, 2013 on thefederalist.com website

Will Insurers Ever Say Enough’s Enough To Obamacare?   As an insurance guy, I liked that it was moving insurers away from their misguided notion of being the big boss in health care and back to the role of financial protection.

But the industry didn’t much like that aspect of it. Sure, they would sell the products because employers demanded it, but they were losing control as banks entered the market to manage the first few thousand dollars of expenses of a patient’s contract. The banks were still focused on financial protection and didn’t have ambitions to become health care managers.

  • So when Obama came along with an offer to require all Americans to buy their products, it was an offer they couldn’t refuse. Especially when the products he had in mind were comprehensive, cover-everything health plans. No more bank involvement. We’ll really be in the catbird seat now!

I’ve been working professionally in health policy since 1979 when I was hired by the Blue Cross Blue Shield plan in Maine. Before I left the Blues I was heading the state relations department for the national association in Washington. Then I went on to organize a trade association of health insurance companies that were interested in promoting free market solutions in health care.

What has happened to the insurance industry has me stunned.

Now, I am no apologist for the industry. I have been one of its biggest critics. Its dalliance with Managed Care was an enormous mistake that took its mission away from financial protection into health services management – something it was never qualified to do.

  • The industry not only did a poor job of it, but it alienated and embittered the only people who really matter in health care – doctors and patients.

Granted, Managed Care pleased employers for a few years. It restrained their costs in the mid-1990s. But employers don’t really know anything about health care, either.

  • What they do know is the morale of their workers, and Managed Care was the biggest morale-killer ever. Employees were furious that care was being denied by insurance company bureaucrats in Hartford, Connecticut, and they let company HR departments know it.

Employers started looking for other ways to restrain costs while preserving patient choice, and came to embrace “consumer-directed” health care (CDHC) in the early 2000s. This approach has been enormously successful and it has lowered costs and increased patient involvement in health care decision-making.

The naivety I had witnessed during the Clinton Wars was still in force. Many of us tried to warn the industry that they would regret this arrangement. Yes, they might be assured of modest profits, but the cost of sacrificing their autonomy would be far too high. They would become little more than public utilities. They would lose all control over benefit design, marketing practices, and rate setting. They would have no idea of the risks they were enrolling and would have to set premiums blindly.

It has become much, much worse than I ever imagined. Obamacare is not even fully in effect yet and already we are seeing the President playing with the carriers like a toddler plays with toy trucks –

  • Employers will be mandated to buy your policies for 2014
  • (Oops, employers are angry)
  • Employers won’t be mandated until 2015 – if then
  • Small employers will give workers a choice of health plans through the SHOP program in 2014
  • (Oops, we can’t get the web site ready in time)
  • Small employers won’t have to offer a choice of plan until – sometime later
  • You must cancel these individual policies
  • (Oops, public backlash)
  • You must reinstate these policies
  • (Oops, many insurance commissioners won’t allow it)
  • You must continue to cover providers and drugs even for cancelled policies
  • The deadline for enrollment will be December 15, 2013
  • (Oops, web site problems)
  • The deadline for enrollment will be December 23, 2013
  • (Oops, too much traffic)
  • The deadline for enrollment will be December 24, 2013
  • Never mind, there is no deadline
  • First month’s premium must be received by December 31, 2013
  • (Oops, back-end problems with the web site)
  • First month’s premium must be received by January 8, 2014
  • Make that January 10, 2014

How can anyone run a business this way? This is worse than being a federal agency. No federal agency would be expected to stop and start on a personal whim like this. These aren’t rules, they aren’t regulations, they are dictates based on nothing more than Kathleen Sebelius’ momentary feelings.

  • These are only the “glitches” that have been made public. God knows what orders and threats are being issued in closed-door meetings.

How long will the insurance industry abide being treated like shoe shine boys? Mr. Obama will not be in office forever. His regime is already coming to an end. What will these companies do then? He will no longer be around to grant or withhold bailout (“risk corridor”) money.

 

0

Many who enrolled in health plans still await confirmation

Anxiety grows as health plan delays could leave some customers without a policy by January 1st.

Some people who picked a health plan as far back as October through the Covered California exchange say insurers are telling them they still have no record of their enrollment. As a result, bills haven’t gone out and consumers can’t pay their initial premium to ensure coverage takes effect in less than three weeks.

“There are certainly some people who have enrolled or think they have enrolled and haven’t received confirmation,” said Paul Markovich, chief executive of Blue Shield of California. “It’s our version of Black Friday right now and that is what we are coping with.”

In California, insurers are working with the state exchange on how to address the potentially thorny problem of patients who applied in time but don’t have proof of insurance when they need to visit the emergency room or get a prescription filled in early January.

Insurance companies typically won’t cover any medical bills until a customer pays the premium. The deadline for payment was recently extended to January 6th.

Thousands of Californians have overcome long waits and website glitches to sign up for Obamacare insurance, but now enrollment snags may prevent some of them from actually having coverage starting January 1st.

Consumers’ anxiety has grown as they endure long waits on the phone, computer errors and conflicting answers from the state and insurers about their coverage.

The average wait time at the state’s call centers climbed to 36 minutes last week, and California is still trying to clear a backlog of paper applications filed in October and November.

State officials acknowledge there have been delays, but they say the vast majority of people are enrolling smoothly and getting their first insurance bills. The state said it didn’t have exact figures on how many customers are still waiting for proof of insurance.

Thursday, Covered California said more than 156,000 people had enrolled in private health plans through December 7th. An additional 179,000 Californians have qualified for an expansion of Medi-Cal, the state’s Medicaid program for the poor.

The stakes are big for people with chronic health conditions and serious medical issues. The loss of coverage could pose significant problems for them financially and for their health.

Lee, head of Covered California, said exchange employees are working overtime to process applications, and the state’s call centers will be open the next two Sundays to help meet increased demand. He said the exchange is sending customer files daily to the 11 insurers participating in the state marketplace.

The separate federal exchange for 36 other states has been trying to fix errors in the customer files it has sent to insurance companies. In contrast, the California Assn. of Health Plans, an industry group, says the information from Covered California has had a “high rate of accuracy.”

*Modified from a LATimes.com article

0

Finding health plans that include the doctors you want

Many consumers shopping for coverage through Covered California have trouble finding policies that include the doctors and hospitals they’re accustomed to seeing.

  • To make insurance affordable, insurers are seeking to control costs in part by limiting the number of doctors and hospitals included in their networks.

Shopping for doctors is never easy. This year, the state’s new health exchange seems to be making it tougher than ever.

  • Most of the insurance companies on the exchange are offering provider networks that are far narrower than those sold on the market today. Blue Shield is offering a network through its exchange plans that represents roughly 37% of its full network.

Many consumers who currently have insurance and are shopping for a new plan through Covered California are finding it difficult to locate policies that include the doctors and hospitals they’re accustomed to seeing.

Covered California issued a report last week saying that more than 58,000 physicians were available through the exchange’s plans, compared with the 63,000 to 72,000 physicians in the state’s largest commercial networks.  But how that plays out for consumers probably depends on the specific plan they choose.

  • In many cases, even doctors themselves are unsure of their status in the new plans. Insurers have a long history of inaccurate and outdated provider listings, which the law does nothing to fix. And the provider lists found on Covered California have themselves been riddled with errors.

*Modified from a LATimes.com article

0

Insurers limiting doctors, hospitals in health insurance market

The doctor can’t see you now. Insurers in California’s new health insurance exchange are holding down premiums by limiting choices, raising concerns that patients will struggle to get care.

  •  To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening Oct. 1.

New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law. These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation’s biggest healthcare expansion in half a century.

  • Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor. “These narrow networks won’t work because they cut off access for patients,” said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles. “We don’t want this to become a roadblock.”

To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc. Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases.

  • Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.

In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That’s less than a third of the doctors Health Net offers to workers on employer plans.

In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

  • Other major insurers have pared their list of medical providers too, but not to Health Net’s degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network.

In response, California officials have been pressing Health Net and other insurers to add more doctors since companies filed their initial rosters in May. The state exchange, Covered California, says it will monitor enrollment closely once it begins next month and it’s prepared to step in if problems arise.

“Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need,” said Peter Lee, executive director of Covered California. “That means if a plan can’t serve patients, we’ll close it down from taking new enrollment. That is in some ways the nuclear option.”

In recent months, the top priority for state officials and insurers has been affordable premiums. A smaller panel of doctors and hospitals generally yields lower rates because insurers can negotiate better discounts with providers who receive more patients.

  • The California Medical Assn., which represents more than 37,000 doctors statewide, thinks the state is underestimating the difficulties ahead. Based on its research, the organization is skeptical of the state’s claim that its health plans will cover about 80% of all California physicians. Other doctors worry about the effect on certain Latino and African American communities that have been historically underserved.

But some health policy experts say that medical costs will continue to escalate if patients can’t see their doctor regularly and get the follow-up care they need for chronic conditions such as diabetes. Similar concerns over patient access have surfaced in other states such as Maine and Wisconsin.

  • “We are nervous about these narrow networks,” said Donald Crane, chief executive of the California Assn. of Physician Groups. “It was all about price. But at what cost in terms of quality and access? Is this contrary to the purpose of the Affordable Care Act?”

The federal law requires exchange plans to include enough providers so that services are available “without unreasonable delay.” Likewise, state law sets various requirements for “network adequacy” so patients have enough doctors and hospitals nearby.

  • The differences in network size are noticeable across Southern California. Health Net has 920 physicians in Orange County, compared with more than 2,500 for Blue Shield, according to company data.

Health Net has fewer than 800 doctors in San Diego County, while nearly 3,000 physicians are available in an Anthem Blue Cross plan.

  • In addition to doctors, some big-name hospitals may be left out. A spokesman for Cedars-Sinai Medical Center said the hospital has received many calls from patients who were worried about keeping their access to the hospital and its affiliated doctors in the new health plans next year.

*Modified from a LATimes.com article

 

0

Uh oh: 7 in 10 Doctors Boycotting California’s Obamacare Exchange

 Another glaring example of why the ‘if you like your doctor, you can keep your doctor’ mantra President Obama and other ACA enthusiasts touted is simply false: An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

  • “It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association. Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.
  • He called the exchange’s doctors list a “shell game” because “the vast majority” of his doctors are not participating. Why? Because when asking physicians to participate in the exchange, the memorandum of understanding failed to provide reimbursement rates. As expected, few physicians were willing to blindly agree to participate without knowing what the rates would be.
  • “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.
  • California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.
  • In other states, Medicaid pays doctors $76 for return-office visits. But in California, Medi-Cal’s reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor. In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160, Mazer added.
  • Only in September did insurance companies disclose that their rates would be pegged to California’s Medi-Cal plan. That’s driven many doctors to just say no.
  • Who would have guessed? Physicians, like I’m sure most working adults, would rather not be paid a fraction of what their services are worth, so are choosing not to participate. This in turn means the pool of doctors available to patients will be smaller. And worse yet, they’re currently being led to believe that more doctors are participating than actually are.
  •  “Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy. “They may be listed as actually participating, but not of their own volition,” said Donald Waters, executive director of the Alameda-Contra Costa Medical Association.
  • Waters’ group represents 3,100 doctors in the East Bay area that includes Oakland, with an estimated 200,000 uninsured individuals.    “This is a dirty little secret that is not really talked about as they promote Covered California,” Waters said.
  • All of the changes and uncertainty in the health care industry are also, not surprisingly, leading many doctors to consider retiring early. “I just turned 55, and a lot of us are kind of going, ‘Maybe there’s something else we can do in the last 10 years,’ because this is just getting too onerous to keep on going,” said Dr. Theodore M. Mazer, the Washington Examiner reported.
  • Once again, enrollment does not mean access to care. “[T]here aren’t enough doctors to take the low rates of Medicaid,” said Alex Briscoe, health director for Alameda County Health Care Services Agency, the Washington Examiner reported. “There aren’t enough primary care physicians, period.

Modified from a Townhall.com and a Washington Examiner article

0

Up to 35K ObamaCare Applications Still Not Entered in California

California residents who have signed up for health insurance on the state’s exchange to make sure they are covered on Jan.1 could still find themselves uninsured in the new year by no fault of their own. 

  • As many as 35,000 of the health insurance applications faxed in to Covered California, the state’s insurance exchange, have yet to be fully entered into the system, according to Sam Smith, president of the California Association of Health Underwriters, and the clock is ticking. In order to be covered by Jan. 1, Smith says California applications need to be fully processed by Dec. 23 and premium checks need to be postmarked by Dec. 31.
  • FOXBusiness.com learned on Thursday that the ObamaCare exchange in the Golden State is scrambling to get faxed applications into the system and none of the applications have been submitted to insurance carriers. “These people who think they were covered may be in for a holiday surprise,” says Smith. 
  • He says Covered California had been instructing brokers and agents to fax in applications from the first day the exchange opened on Oct. 1 because the website was not yet fully functional. If insurance companies haven’t received the applications, they can’t process them and fully enroll the individuals. And with so little time left, Smith is skeptical that verification and payment for premiums can be fully completed by the deadline.  

Mismanagement Leads to Major Logjam

  • Smith says it is standard practice in the insurance industry for scanned applications to be uploaded into databases automatically. After it’s scanned, brokers verify the information is correct before final submission.
  • At Covered California, however, the paper application differs from the online application – meaning that all faxed-in applications need to be manually entered into the database. This process, which can take up to two hours per application, has created a tremendous logjam for the state exchange, which Smith says has received anywhere from 23,000 to 35,000 applications by fax.
  • “The person that’s looking at this application and inputting the data has to be putting the information in by hand, and the [questions] are not in the same order as the data screen so you have to go back and forth, back and forth, which causes errors and adds time,” says Smith.
  • “They don’t have the manpower – now they’re telling us they won’t have the manpower.” Covered California is now asking brokers for their help—but it may be too late.
  • Smith says Covered California’s plan is to upload some of the basic information for each application, save it, and then send an online request to the broker who submitted the application. At that point, the broker can accept the request and fill out the application themselves – assuming they have the two hours necessary to finish the process.
  • If the enrollment process isn’t fully completed and the check isn’t postmarked by Dec, 31, coverage cannot begin on Jan. 1, says Smith. He is highly skeptical that brokers will be able to shepherd this process fully by the deadline.
  • Smith says the whole process could have been avoided if the website’s contractor had followed industry protocol regarding the applications, or had Covered California come forward with the truth and reached out to brokers for help earlier this fall.
  • “It’s a management issue. We may not like it, but the truth is our friend,” says Smith.

*Modified from a FoxBusiness.com article

0

Obamacare: You’re not insured until you pay

Just because you’ve picked an Obamacare insurance policy doesn’t mean you’ve got coverage. If you want to be insured come Jan. 1, you have to pay your first month’s premium by your insurer’s due date.

  • Sounds simple enough, but federal officials and insurers are concerned that many consumers don’t realize they have to take this last step and will remain uninsured. What’s more, those who don’t pay by then may have their Obamacare applications terminated, forcing them to re-enroll for coverage that will begin later in 2014.
  • The tight deadline and continuing errors with consumers’ applications being sent to insurers also risk leaving some folks uncovered. Obama administration officials are advising consumers to check with their insurer of choice to make sure it received their application and payment and that coverage will begin Jan. 1.
  • Here’s the timeline: Consumers have until Dec. 23 to pick an insurance plan on an exchange handling enrollment for 36 states, if they want to be covered at the start of the new year. Once they do, a final screen confirms they’ve completed their application, but warns that they have to pay their first premium for coverage to be activated.
  • The site then provides a payment button that takes them to their insurer’s website. Some companies accept online payments, but others give consumers information about how to take care of the bill. Those who live in Californian have until Jan. 6 to make their first payment. Those planning to sign up this month should check the deadlines of both their exchange and their chosen insurer.
  • While the Obama administration has reported that more than 100,000 Americans picked plans in October, the first month of open enrollment, it’s not known how many of them have paid.  If payment isn’t made by the due date, the insurance carrier must void the application.
  • Another complication is that insurers also don’t have a lot of time to process applications and send out ID cards. The timeline, particularly over the holiday week, will prove “challenging” for some companies, one industry executive said.
  • The process is being further complicated by the fact that insurers are receiving applications from Exchanges that contain errors, such as missing data. Some applications aren’t getting through, so insurers don’t know to follow up with these folks. Both of these problems are slowing down the enrollment process.

*Modified from a CNNMoney article

0

California votes against extending canceled health policies

Spurning President Obama’s plan for canceled policies, California’s health insurance exchange voted against any extension for about 1 million policyholders in the state. The five-member board of the exchange voted unanimously to keep its current requirement that insurers terminate most individual policies Dec. 31 because they don’t meet all the requirements of the Affordable Care Act.

  • The decision ends a weeklong drama over what would happen for policyholders who will lose their existing coverage at year-end and face finding replacement insurance that may cost them substantially more in many instances. Covered California, the state exchange, considered allowing renewals into 2014 as Obama proposed or a short-term extension through March to give people more time to shop.
  • But state leaders ultimately rejected those options. They expressed concerns about further confusing consumers and worried that widespread renewals could keep too many healthy customers out of the broader risk pool that will shape future rates.
  • “We know this transition is difficult and some people will be hurt,” said Covered California board member Susan Kennedy. “But delaying the transition won’t solve a single problem.”
  • Covered California said 79,891 people have enrolled in private health plans through Tuesday. The state has outperformed the troubled federal exchange, which has struggled with an error-prone website and meager enrollment.

Modified from a latimes.com article

0