Month Six

(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. 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 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 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 50th 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 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 15th to the 23rd.  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 15th 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 1st.  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 9th 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.

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2 Responses to Month Six

  1. Michael J. Saltzman says:

    “They suffer most from the intake of Sodium by choice.” – David’s Ankles

  2. says:

    A salty comment from my favorite attorney.

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