The calls started coming in last week.

Dave, I want to keep my current policy.

Well of course you do.  We had this conversation in October.

Yeah, well I got a letter that said that I had to call in to Medical Mutual if I want to keep my policy, so I called you.

You got a letter?  I wasn’t copied.  I have no idea what you’re talking about.  Would you read the letter to me?

The client read the letter to me over the phone.  It was long and rambling and sounded more like a request for him to dump his old cost effective policy in favor of a new contract than anything else.

That came from MMO?

Yes.  It came in today’s mail.

Do me a favor.  Scan and email it to me or fax it over.

The letter had, in fact, been sent by Medical Mutual to the client.  Identical letters were sent by the insurance companies to all insureds with non-grandfathered policies.  Identical.  The letters were prepared by the Department of Health and Human Services (HHS).  The insurance companies were forbidden to move a comma.  If the objective was to confuse and/or frighten the people who have to this point avoided the government’s website, then they have finally managed to find an achievable goal.

Some Americans are well-served by the new health care law.  If you are purchasing insurance for yourself and your family and you

• Need maternity coverage
• Have preexisting conditions
• Would qualify for a premium subsidy

You might benefit from a new health insurance policy.  But if you are healthy and/or don’t qualify for the subsidy, you probably want to keep your old policy.

A surprisingly large number of people want to keep their old policies.

The initial pushback resulted in the Obama Administration granting Transitional Relief, the ability to keep certain existing, non-grandfathered policies for 2014.  The Centers for Medicare and Medicaid Services (CMS) announced in March that we were getting another 2 years and possibly more.

The Good News – My current policy is $400 per month less than a comparable 2014 plan.  I am not alone.

The Bad News – Allowing the healthy to avoid the Patient Protection and Affordable Care Act (PPACA) for another couple of years spells higher rates for those in the system.

So to avoid upsetting millions of people the President and CMS are letting you keep your current policy.  To avoid upsetting millions of people with ridiculous rate increases HHS is trying to get you to voluntarily dump your old policy.  Hence the letter.  If you give up your current policy, as opposed to having it taken from you, then you are part of the system by choice.

Don’t Do Anything

If you get the letter, the one that tells you that you can keep your current plan and then lists eight bullet points of what you are missing by not switching to a new health plan, you don’t need to do anything.  Nothing.  You will still get your renewal notice in a timely fashion.  You will have the opportunity to keep your current policy and pay the new 2014/2015 rate.  Or you will be able to shop for a policy under the new rules.  There is no need to do anything today.  That especially means that there is no need to get nervous or aggravated today.

The government’s website, the national frustration number, and letters like this prove again that the people in charge really didn’t know what they were doing when they invaded my business.  The purpose of insurance is twofold – money and peace of mind.  You write small checks to the insurance company so that if, G-d forbid, you get really sick or injured we’ll write the really big checks to the doctors and hospitals.  And peace of mind, the knowledge that this will all work.

There is no gobbledygook on the path to peace of mind.

It was an ugly, ugly bedroom.  The only solution I could think of was to scrape off the seven layers of paint and wallpaper to get back to the original plaster.  At that point we would be able to make the room ready for my daughter.  It was the spring of 1983 and I was living in University Heights.  The work was backbreaking and monotonous.  Success was measured in inches.  “Surely there must be a better way of doing this”, was muttered on an hourly basis.  I even wondered if it would have been easier to just knock out the walls and hang new Sheetrock.  But we persevered because we knew why we were doing this.  We were doing this for Jenny.

Is the effort worth it?  Are our goals worthy of the time and effort it might take to achieve them?  That question pops up again and again when we look at the Patient Protection and Affordable Care Act (PPACA).  We were told that there were 50,000,000 uninsured Americans and that the PPACA would solve this problem.  We were told that the cost of insurance and the actual cost of healthcare would decrease.  We were promised easy access to affordable care.

Are we there yet?

 According to the Gallup Pole published in March 2014, the number of uninsured in the United States has decreased.  Of course, that number has steadily INCREASED until it peaked in the middle of last year.  But now it is going down.  Gallup conducted more than 28,000 interviews and has determined that 15.9% of all Americans are uninsured.  With a US Population of Approximately 318,000,000, that would mean that about 50,562,000 of us are uninsured.  For comparison sake, the uninsured rate was in the 14% range until the crash at the end of 2008 and did not exceed 17% until the middle of 2011.

It might be fair to ask if the new law is really having any impact on the number of uninsureds.   Is the economy, slowly recovering, the reason more people are now getting coverage?  Or it could be the expansion of Medicaid in those states that chose to fully cover the working poor.  It is way too early to tell.  The numbers released so far, rounded to the nearest hundred thousand or so, are neither firm nor reliable.

Allow me to provide you with a small but accurate sampling of the individual health insurance market in Greater Cleveland.  I wrote 62 contracts (individuals or families) during the first three months of 2014.  Here is the breakdown:

On Exchange (Subsidy Eligible)                                                                  Off Exchange

23                                                         Contracts                                            39

48                                                 Insured Individuals                                     66

7                                                 Previously Uninsured                                  10

15%                                                  Newly Insured                                        15%

Twenty-three individuals or families successfully purchased a policy with me on the new exchange.  We only used the exchange because they are going to receive a tax subsidy to help to pay for the policy.   There were a total of 48 people involved and only 7 of them, 7 total adults and children, were previously uninsured.  The other 41 changed coverages to get cheaper insurance or to pick up maternity.

My Off Exchange experience is essentially the same.  Thirty-nine individuals and or families applied for coverage.  Of the sixty-six people covered, only 10 had been previously uninsured.  The balance purchased policies, in many instances, because we are no longer rating for risk.  In other words, these are individuals and families who may have paid a lot more for coverage in the past due to their preexisting conditions.  Their conditions and the cost to treat them didn’t disappear, just the money it took to cover the risks.

It is my experience, with my admittedly little sample, that only 15% of my transactions involved covering the uninsured.  Most of this is simply shifting risk and cost.  People with lower incomes have shifted a large chunk of the cost of insurance to the US taxpayer.  Unhealthy people have shifted the risk of their insurance to the general population.  The uninsured, the people who would be swamping our offices (sarcasm intended), didn’t stand in line outside of my door.

I talked with an uninsured gentleman this morning.  Harry (name changed) lives in Parma.  He is 62, uninsured since he left his last job in 2010, and has no interest in spending a dime more than necessary.  He has pension, savings, and is getting by.  He uses the word Obamacare like expletive.  Why did he call my office?  It may be because his right knee, the one that was surgically repaired in 2009, may be acting up.  It could be because his buddy is in the hospital and he got scared.  Who knows?   Harry didn’t purchase coverage when we talked in October and he didn’t do anything today.  And he won’t do anything this November at the Open Enrollment unless that knee starts to really hurt or that buddy dies.

So please remind me why we did this.  Did we need to destroy the village to save it?  Was it worth it?  If our goal was to cover the uninsured and the working poor, we could have done a better, more thorough job expanding Medicaid.  The rest, affordability and patient protection, seem just beyond our reach.  But it is only June 2014.  It is still too early to tell.

 NO!

February 11^th.  The young family applied for health insurance on the government’s exchange on February 11, 2014.  It was a frustrating experience that resulted in the young husband and his child being invited to apply for health insurance.  They were even offered financial assistance.  The 22 year old mom?  The feds thought that she’d be better off with Medicaid.

We tried to fix this.  No luck.  Nothing could be done about this error until the State of Ohio reviewed her case and ruled that she was not eligible for Medicaid.  We applied for the subsidized health policy for the father and son.  We kept the woman on her existing coverage.

The notice was dated Sunday, May 4, 2014.  Ohio, swamped with over 300,000 new Medicaid enrollments since last fall, finally got to my client’s paperwork and declined her.   She is now officially eligible for the subsidized health insurance that she should have been able to purchase months ago.

No, for once, is the answer you want to hear. 

My clients are responsible people who have always had insurance and always will.  They found a way to put the monthly premium into their budget.  But what if they couldn’t?  This is a huge problem that has not been resolved.  I am still having clients incorrectly shipped off to Medicaid.  And what if the client has any ongoing health or financial problems?  Then he is screwed.

In the last month I have had numerous conversations with CMS and federal exchange employees, Senator Brown’s staff, and our elected officials in Columbus.  Our main topic was how to make The Patient Protection and Affordable Care Act (PPACA) work better.  Some of what I’ve learned was told to me in whispers.  Some of what I’ve learned from experience has been grudgingly confirmed.  And of course, there are glitches and problems that no one will acknowledge.

• Healthcare.gov works best when using all capital letters and your Chrome browser.
• Do not show a husband and wife earning the same exact monthly income.  It throws the system.
• Healthcare.gov has a big problem with large families.
• Ditto newborns.
• Unofficially, part of healthcare.gov’s problem is that there was this assumption that it would be serving the uninsured.  The government’s exchange defaults to Medicaid.  You must qualify OUT of total assistance to earn a subsidy.
• Undertrained, unprepared, and overworked, the call center workers shouldered a huge part of the burden.  They are now fielding fewer, but more intense calls.  Sitting in a cubicle, forbidden to use paper or pen to take notes, and unable to email for help, the call center assisters are totally overwhelmed by service issues.  I have talked with healthcare.gov veterans (8 months!) who are willing to try trial and error to solve problems.  I’ve also had them hang up on me.

This is my work environment.  The State of Ohio has just about cleared its back log of Medicaid applicants.  Many of our citizens have recently learned that they will now have access to the health care that they need.

And a few of my clients will get the letter they really want.  They will be declined for Medicaid and will now be able to buy an affordable policy.

Room 113.  The name plate on the massive wooden door identified this room, located down a hallway in the Statehouse, stuck between a stairwell and the men’s room, as the William Henry Harrison Room.  Our ninth President, who served a little more than thirty days, merits the honor of a room, just not a really good one.

So much of our politics resembles Room 113.  Style vs. Substance.  The appearance of action attempting to replace actually doing something.

I was in Columbus to meet with Members of the Ohio House and Senate.  It was our annual Day at the Statehouse, an event organized by the Ohio Association of Health Underwriters.  Our task is the same every year – how can we help our lawmakers to make it easier for Ohioans to get the health insurance they want and need.

The last few years have been more challenging.  We, the State’s insurance agents, are uniquely qualified to explain how the Patient Protection and Affordable Care Act (PPACA) has helped and hurt Ohioans.  We know where Ohio laws and regulations have protected our clients.  We also know where our State’s laws and regulations have made the acquisition of insurance more difficult or even nearly impossible.

Our annual visit to Columbus has become more difficult.  Democrats are loathe to admit that the PPACA needs to be tweaked, lest that admission be perceived as a sign of weakness.  And Republicans are afraid to acknowledge that anything, ANYTHING, good came from Obamacare.  Republicans control the House and the Senate.  Governor Kasich is a Republican.  More and more of them are beginning to concede, albeit quietly, that the law is here to stay.  But moving to make the law more functional is still tricky.  And with the Republicans controlling the House, the Senate, and the Governor’s Office, it is up to them if anything is to be done.

Roaming the halls of our Statehouse, I met legislators from both parties who honestly, sincerely want to have a positive impact on the lives of average Ohioans.   I met aides clearly aware of pending legislation in both chambers.

So this was a good year.  But there are still lots of members, from both sides of the aisle, that have no interest in details, regulations, or functionality.  Instead, every issue for them boils down to the lowest common denominator of Us vs. Them.

And while they are busy scoring points, we are stuck waiting for the State to make it easier for Ohioans to get health insurance.  Eleven and a half million people stuck in Room 113.

DAVE

Coming soon:  No?  Did you say No?  Thank you!

Bloody.  Broken.  I was flat on the mat.  I had thought that I could go the distance.  But now?  Now I wasn’t so sure.  I pulled myself up and tried to clear my head.  The referee administered a standing 8 count.  And I knew, I knew, that if I was to see this fight to the end, if I was to have a chance of pulling off victory by decision, I needed to appeal to a Higher Power.  I looked up and called upon the only One who could help me.

I contacted Senator Sherrod Brown.

J. Bradley Deane is a Staff Assistant working in Senator Brown’s Cleveland office.   Two minutes into our conversation I was sure that I was dealing with a problem solver.  No excuses.  No sales pitch.  He quickly grasped the problem and offered to help.  He let me know that some problems were solved within a few working days and that some weren’t, but that he would stay involved.  And I believed him.  I received the required release form moments after our call ended.  I turned the paperwork around quickly and he had what he needed by the end of the day, Thursday the 17^th.

The insurance company was contacted by the government by the following Tuesday.  And I can report to you that R.S. and his son are now properly insured with a policy that is correctly dated April 1, 2014.  The client no longer needs to worry that his policy is going to lapse due to this glitch.  Neither R.S. nor the US taxpayers were forced to waste thousands of dollars for nothing.

Unanimous Decision – Cunix in 10 rounds!  

Could I win two battles in one day?  I had my doubts.  In last week’s post I detailed the difficulty of adding a newborn to an existing exchange policy.  Difficulty may be an understatement.  I had more hours and more frustration attached to this (previously) simple service issue than I had invested with R.S. and his son.  No one could say with any degree of certainty who was insured.  The insurer had part of the family.  The mother supposedly had a one-way ticket to Medicaid.  And I was afraid that the whole family might find itself uninsured, collateral damage of The Patient Protection and Affordable Care Act (PPACA).

Looking for an entirely different path, I contacted Sam Fiorentino, Past President of our local Health Underwriters chapter.  Sam suggested a miracle worker in the Chicago Centers for Medicare and Medicaid Services office (CMS), Ms. Monaghan.

Is Ms. Monaghan a miracle worker?  I don’t know.  I can tell you that she returns phone calls, works crazy hours, and is doing the best she can within a badly designed system.  I can’t say whether her efforts directly or indirectly led to a solution.  But at 5:09 PM today, according to the national call center’s records, my client, his wife, and all of his children are on the same policy.  A request has been filed to have a caseworker follow up with the insurer to make sure that there is no lapse in coverage.

TKO – Cunix in the 12^th round! 

So what did we learn from all of this?  The first and most important thing is that ALL PROBLEMS can be solved.  All you need is the tenacity to follow through and at least one person on the other side willing to do what is right.

We learned that CMS knows that there are glitches and flaws in their program.  Specialists and troubleshooters have been assigned to find solutions on a case by case basis.  It also appears that an effort is underway to eliminate the root causes.  My clients weren’t the only people who experienced these service debacles.  Admitting that is a first step to earning our confidence.

We learned that it might not take an act of Congress to get something done, but it never hurts to get a member of Congress to help you.

And, we are again reminded that we have to be willing to fight, to invest the time and effort, to get what we know is ours.  Sitting back, whining, and waiting for the world to give us what we think we deserve will never get us a victory.

If you think that you are right.  If you think that you aren’t getting what you deserve.  Put on those gloves and climb into the ring.

We interrupt the ongoing saga of R.S., the client who magically received the retroactive insurance policy, to bring you an important warning. It appears that I have found the one thing you can do as a consumer that will absolutely tilt the out-of-balance pinball machine that is Healthcare.gov.

Do Not Have A Baby

One of the hallmarks of the Patient Protection and Affordable Care Act (PPACA) is that maternity coverage is built into all of the policies. We now cover maternity the same as any other illness. The deep thinkers in Washington inserted coverage for contraceptives and for pregnancy. They just are totally unprepared for the results of a successful pregnancy. The perfect Obamacare pregnancy lasts 78 trimesters!

I have had two clients attempt to add newborns to the government’s exchange. Remember, the policies purchased through the exchange are just like policies purchased directly from the insurance companies. By taking you through the exchange I may be able to get you a subsidy. The trade-off was that you gave the government a lot of personal information and the government helped pay for your insurance premium and possibly even some of your deductible. Since it is pretty clear that the government already has access to all of this information, why not take the money?

What we didn’t know was that we were also adding the government’s inept bureaucracy into every little transaction. 

Adding a newborn to his/her parent’s policy was one of the easiest and most positive tasks I had as an insurance agent in the old days (prior to January 1, 2014). The process was nothing more than a quick signature on the form that showed the child’s name and date of birth. Couldn’t have been easier. But any change, ANY CHANGE, on the exchange requires a whole new application. You may remember that ridiculous series of questions about whether or not you were a US citizen and what ethnic heritage you chose to acknowledge. And of course you also had the opportunity to verify that each of your children were not only your children but the actual brothers and/or sisters of your other children. This mind numbing experience is also a mine field. Every single entry is the portal to another site crash. On a perfect day, with a tiny family, this may take only an hour.

But not every family is tiny. And there are no perfect days with healthcare.gov.

The client and I thought that this was going to be a simple process. After all, the exchange had plenty of time to prepare for the Special Enrollment Period that began in earnest when the Open Enrollment Period ended. He thought that it would take 10 minutes. I guessed an hour. After an hour and a half, I had not only failed to add the baby to the policy, I had also lost the subsidy for the mother. Yes, the exchange had sent another woman to Medicaid even though her income was nowhere near the required amount.

Both the client and I had had enough for one day. We got back together at his office this morning. We began the process at 11 AM. Two representatives, two specialists, and three documented system failures later, we were told that there was nothing else we could do today. It was exactly 2:30 PM. I had been chained to the phone and computer in his office for three and a half hours. The client’s wife is no longer being shipped out to Medicaid. Our problem, the government’s inability to simply add a newborn, has now been “escalated” (official term!). The client has been promised a call in 3 – 5 business days from a different office.

The baby is still not covered. 

What once took moments may now require an act of Congress.

DAVE

Insurance company greed on one side – government indifference and incompetence on the other.  My client?  He’s stuck in the middle with me. 

You were introduced to R.S. in last week’s post.  Quick summary – R.S. purchased a health insurance policy for himself and his son on the exchange.  The date was February 27^th.  He was sitting in my office.  The coverage would, by law, begin on April 1, 2014.  Weeks later he discovered that the insurer, one of the big ones, issued the policy with a January 1^st effective date.  Getting three months premium for nothing, the insurer told the client and I that this was our problem not theirs. 

Would the government jump at the opportunity to save over a thousand dollars? 

April 2, 2014 – My first stop was, of course, healthcare.gov, a website that wasn’t designed to create unsolvable problems, it just does that naturally.  Once I had verified that this situation could not be addressed on the site, I reluctantly called the national frustration number, 1.800.318.2596. 

I was talking with an exchange representative in just a little over fifteen minutes.  It took another ten minutes, but I succeeded in getting her to admit that yes, R.S. did complete an application on February 27^th.  And yes, his policy was somehow pre-dated to January 1^st.  BUT, she couldn’t talk to me since this had all happened more than 14 days ago and I was no longer authorized to help my client.  Since he wasn’t sitting next to me, she couldn’t (wouldn’t) do anything about the screw up. 

“You don’t need an authorization to do the right thing,” I said to the woman invading my profession.  This thought, this idea that we are here to solve problems, was totally foreign to her.  Dead end. 

April 7, 2014 – 10:30 AM with R.S. in my office

Spoiler Alert – If you want a Happy Ending you’ll need to visit a different blog. 

This started out promising.  My phone timer showed that we were talking to a helpful rep in only sixteen minutes.  He took our info, added me into the system for the next fourteen days, and acknowledged our issue.  He then explained that he would need to transfer us to a specialist.  Not a problem.  We looked at the timer.  27 minutes.  Then we heard the dial tone! 

Round Two – Our second foray wasn’t nearly as fruitful.  It again took over fifteen minutes to get through the system to reach a live person.  Unfortunately, the woman we reached resented our intrusion into her naptime.  She decided to punish us by asking a long series of irrelevant questions.  Disappointed that we hadn’t hung up, she finally asked why we had called.  We told her and she agreed to transfer us to a specialist. 

Hold music!  We have achieved hold music. 

And we waited. 

R.S. had only allocated an hour for this little task.  He stayed till noon, 30 minutes extra.  I’m still on hold. 

We all have certain challenges.  Much of the Patient Protection and Affordable Care Act (PPACA) has seemed like nothing more than an endurance test.  And when you are on hold for over an hour, chained to your desk, unable to leave, unable to use your phone, this devolves to nothing more than a test of wills.

Hour and a half on hold – still here. 

Two hours – still here. 

I was about to give up.  I really had other stuff to do.  It had been three hours since we had made the first call.  Five more minutes.  I had decided to give that damn hold music just five more minutes when the music stopped and a recorded voice came on the line.

“Your call can not be completed at this time.  Please call back later.”  CLICK! 

Now what?  Do any of us really believe that R.S. is the only victim of this particular glitch?  How many months’ of unearned premiums are the insurers collecting?  How many thousands’ of dollars are we, the taxpayers paying for nothing?  And how many Americans will lose their coverage when the insurer terminates these policies because the people can’t pay these unnecessary charges? But you can’t answer those questions, you can’t even acknowledge that there are even problems, unless you actually care.  AND THEY DON’T.  Not the insurers.  Not the people locked in some cubicle farm near Washington, D.C.  And least of all, not the politicians of either party who are equally responsible for the mess we now have.  

And the client?  He’s stuck in the middle with me.

DAVE

February 27^th.  The client and I, after several failed attempts, finally got all of the way through healthcare.gov on February 27^th.  We chose a policy for him and his son and hit the final button.  The Congratulations screen was anticlimactic.   We were both so relieved that this was over that we just sat there in my office staring at the monitor.  He was IN!  His new policy would begin April 1, 2014.

The client, R.S., and I did have some questions about the policy.  Information was provided on a “need to know” basis and the insurer (who will remain nameless for obvious reasons) decided that my client didn’t need to know anything until he sent in his first premium.  R.S. sent in his check and his card arrived a week or so later.

R.S. may not be an insurance expert, but even he knew that he had a problem the moment he saw his insurance card.  The card said that his coverage had improbably begun on January 1^st!  Worse, a bill for February, March and April quickly followed.  R.S. was being charged for three months of coverage that he had not had.  He had been insured by a different company all the way through the month of March.  Worst of all, the federal government, YOU and I, were being charged for these three months as well.

Billing issues are not insurmountable.  In fact, these are some of the easiest messes to resolve.  Well, usually.  I sent a copy of the erroneous bill and the February 27^th award letter from the exchange to the Agent Services desk at the insurance company.  I acknowledged that this could possibly be a government error or an internal mistake and asked that this be corrected.

I received the following response a little over five hours later:

The member will need to contact the exchange to initiate the eff date correction.

Translation:  We like getting Money for Nothing.  We aren’t going to do anything about this.  Your client can either pay the extra money or fight the government.

Is this problem unique to R.S.?  How has the insurer handled similar situations?  SILENCE.  I immediately asked the following questions:

• Does the insurer have access to his application?
• Does the insurer have access to the date of his application?
• Will the insurer acknowledge that there is a problem?
• What is the insurer’s official position on the client’s issue?

 That was yesterday.  Here is the response I got late this morning:

We do not have access to the on exchange application.  The information we received was provided by the exchange.  All changes or corrections to an application for an on exchange policy are handled by the Exchange.  Thanks,

 In the immortal words of Freddie Prinze, “It is not my job, man”. 

But you know what my real question is.  I want to know what this insurer would have done if the situation were reversed.  How would they have pursued this if the client was scoring three free months?  I suspect that they would be more engaged.

My biggest problem as an insurance agent isn’t the government’s intrusion into my business.  It is our nation’s business schools’ invasion of our industry.  Thirty-five years ago the board rooms of the insurance companies were populated by insurance people, men and women committed to the pooling of risks and to solving our clients’ problems.  Our people worked daily with the nation’s hospitals which were led by physicians who had not forgotten the importance of patient care.  Now the clients are widgets and the patients are units of care. 

Widgets are interchangeable.  Units stack up nicely.  And money stacks up best of all.

I’ve been meaning to get around to it.  It was a great article in Time magazine, I learned some interesting facts, and I wanted to express my appreciation.  It was an article on Procrastination and it appeared in 1979.  And I will get that letter off to them soon.  I know I will. 

Open Enrollment, your chance to purchase individual health insurance, ends March 31, 2014.  That’s it.  We have two weeks left, according to the Patient Protection and Affordable Care Act (PPACA or Obamacare) to get a policy.  On April 1^st the doors are closed and the gates are locked.   

The deadline is two weeks away and the procrastinators are about to be closed out.  And they aren’t alone.   The insurers aren’t advertising.  The State of Ohio is uncharacteristically silent.  A surprising number of people are still trying to determine whether any of this, this Obamacare, has anything to do with them.  Others won’t start looking for insurance until their current policy renews in June or July and their premium goes through the roof.  Boy are they going to be surprised. 

Since we are no longer asking health questions and since preexisting conditions must be covered, there has to be an open enrollment period each year to purchase coverage.  Otherwise, people would wait until after an illness or an injury to apply for insurance.  We can’t have ambulance drivers selling insurance on the drive to the hospital. 

These are the qualifying events for a Special Enrollment:

• Loss of Minimum Essential Coverage (Loss of Minimum Essential Coverage does not include termination due to non-payment of premium, including COBRA premium, or in the event of rescission)
• Becoming a dependent through Birth
• Becoming a dependent through Adoption or placement for adoption
• Becoming a dependent through Marriage
• Error in enrollment
• The plan or insurer substantially violated a material provision of the contract under which you are enrolled
• Newly eligible or newly ineligible for advance payments of the premium tax credit or experience a change in eligibility for cost-sharing reductions through the Exchange Marketplace
• New coverage becoming available as a result of a permanent move 

In simple terms, you must have an insurable event, a major change in your life.  And if you don’t, you will have to wait till the next open enrollment at the end of 2014 for a January 1, 2015 effective date.  Your only other choice will be short term coverage.  

I know, I know.  You are going to get around to this.  No problem.  You’ve still got two weeks.

(The Last Month of Open Enrollment) 

The first open enrollment of the Patient Protection and Affordable Care (PPACA or Obamacare) is coming to an end.   Six months.  Much anticipated.  Terribly disappointing.  We began in October with a system of crashing computer sites and missing forms.  We end way too close to where we began. 

Even with all of the television, newspaper, and magazine stories, an incredible number of people are still surprised when I tell them that there are no longer any health questions on the application.   So, let’s do a quick reminder:

Date of Birth?

Where Do You Live?

Do You Smoke?

Those are the questions, the only questions, used to determine the price of health insurance under the PPACA.  It doesn’t matter whether you purchase a policy through the government website or through an agent, the rules are the same.  Preexisting conditions are covered.  Maternity is covered.  And if your income is low enough and you would like some help in paying the premium, we’ve got that covered, too. 

Healthcare.gov is still a mess.  There are days where it works well.  There are days when it doesn’t work at all.  What many of us have discovered is that success on Healthcare.gov is purely random.  No luck at 10 AM and Jackpot two hours later.  We still have clients misdirected to Ohio Medicaid.  We can still spend an hour and a half, get to the last screen, and watch it crash.  But two weeks ago I zipped through an entire application, start to finish, in less than an hour with a single woman who has had the same job for years. 

Avoid Healthcare.gov unless you are getting a subsidy.  You don’t need the extra steps.  You don’t need the aggravation. 

These posts have detailed the successes and failures of both the government and the insurance companies as we attempt to process the changes our new system has wrought.   And there have been successes, huge victories for the previously difficult to insure.  And there have been moments of terrible frustration, anger, and tears.   

New stuff since the last update: 

Billing – It appears that the insurance companies have forgotten how to generate timely paper bills.  I have clients still looking for their January statements.  Electronic Transfers from checking accounts seem to favor the insurer.  Cancel a policy with certain insurers and the next payment may still disappear from your account.  My suggestion?  If given the option, choose automatic payment from a credit card.  It is much easier to reverse an erroneous charge.  No bounced check charges.  Less hassle. 

Individual Mandate – The House Republicans are set to vote on their 50^th attempt to dismember the PPACA.  Oddly enough, if they had packaged this request, the postponement of the requirement to purchase coverage till next year, with less vitriol, I suspect that it would pass easily.  Too many Americans have given up on Healthcare.gov or have simply chosen to sit out this year for the government to enforce this part of the law.  Postponing the Individual Mandate till 2015 would actually help the Democrats much the same way as skipping the Employer Mandate made the fall of 2013 more pleasant.

Kicking ‘em When They’re Down – An insurer, who will remain nameless, is still digging out from a problem created by a President who was only trying to help.  Call it the law of unintended consequences.  On November 22, 2013, the administration changed the deadline for January 1, 2014 coverage from December 15^th to the 23^rd.  This caused any number of problems for the insurers.  At least one major insurer failed to change the computer programs.  The applications received after the 15^th were coded with a February effective date.  Those people were not in the insurer’s system for January.  No coverage (technically, no coverage without a fight), no billing, no insurance cards.  Worse, when the insurers backed them out of their systems, the new applications were not necessarily reentered in a timely fashion.  Again, this blog will not gloat over this system failure.  I have talked to the employees of at least one of the affected companies.  They are aggravated and embarrassed.  

New taxes – insurers must now collect the following Federally Mandated Fees (Taxes) each month:

PCORI – $0.18

Reinsurance – $5.32

Market Share – 2.4% of the total premium

This money goes directly to the government and the fees are subject to change (UP). 

Short Term Policies – UnitedHealth One is having a banner year in Ohio.  They aren’t on the Exchange and their individual policies aren’t competitive in our area.  Their Short Term Major Medical Policies, plans perfect for those people who choose to sit out 2014 and avoid the PPACA, are very popular.  Cheap and easy wins out again. 

Kicking ‘em When They’re Down II – A woman (not a client) felt compelled to share with me the problems she is having with her current insurer.  The insurer has a well-known name, but does not have much of a market share in Greater Cleveland.  Their reputation was that they were paperwork challenged.  This insurer also undercharged on certain conditions which, of course, was reflected in their over-all rates.  Anyway, she took the time to detail improper charges, months without coverage, and excessive withdrawals from her checking account.  I offered a simple solution, change insurers.  We still have two weeks to get her covered for April 1^st.  She declined.  After all, her current policy is less!  I quoted David Ackles.  “They suffer least who suffer what they choose.” 

Anthem Blue Cross – The senior division, the area that sells Medicare Supplements, Medicare Advantage, and Medicare Part D, has been providing great service to my clients and me.  Of course, the PPACA hardly touched this division.  We are holding out hope that the rest of the company regains solid footing.  

Medical Mutual of Ohio – Sure there have been challenges, but I must report that the last six months have given me a greater appreciation of the employees on East 9^th Street and out in the Strongsville outpost.  Maybe it is the local aspect.  Maybe it is the corporate culture.  Regardless, nobody returns phone calls faster or trying harder to get through this changeover.   G-d knows we’ve given them the opportunity to shine. 

The open enrollment ends in 30 days.  Are you where you want to be?   

Six months and we are still in this together.