First insurance deadline is here

For coverage to start Jan. 1, Monday is last day to sign up

Americans who want to enroll in individual insurance plans being offered under the health-care overhaul law face a deadline of Monday to sign up for coverage that will start Jan. 1.

While enrollment for 2014 will continue through the end of March, meeting Monday’s deadline is important for many of those who are on government programs or private insurance plans that are to end Dec. 31.

In Arkansas, the programs that are ending include the Medicaid-funded ARHealth-Networks, which provides limited health benefits to almost 20,000 people, and a state program that coversabout 2,400 people with medical conditions that had prevented them from being able to buy coverage in the private market.

In addition, two insurance companies that covered about 329 people at the end of last year have said they plan to terminate their customers’ policies at the end of this year.

New coverage options, including plans that are subsidized for people who have low and moderate incomes, are available on health-insurance exchanges that were set up in every state under the health-care law.

But enrollment through a federal website, healthcare.gov, has been hobbledby software flaws and other glitches since the sign-up period began Oct. 1.

Federal officials say they have resolved many of the website’s problems. But The Associated Press reported that the website was down for part of the day Friday as technicians attempted to fix an error that occurred Thursday night as the site was undergoing routine maintenance.

Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield, one of four companies offering plans on Arkansas’ exchange, said the pace of enrollment has “picked up quite a bit” since Oct. 1.

“I think it’s fair to say there was a substantial period of time where there were a lot of problems,” Greenwood said last week. “Clearly it’s improved, and we just hope to see continued improvement and encourage people to go on the website and shop for a plan.”

The original deadline to apply for coverage that will start in January was Dec. 15, but officials last month announced that the deadline was being pushed back to Monday to give people more time to enroll.

Last week, the insurance industry’s largest trade group, America’s Health Insurance Plans, said most insurance companies would give customers who sign up by Monday until Jan. 10, instead of Dec. 31, to pay the first month’s premium.

Mike Stock, chief executive of QualChoice Health Insurance, said enrollment in plans offered by his company has picked up, although the number of people who have signed up with the company is still less than 1,000.

He said his company has been getting 100 or more calls a day from potential customers and insurance agents, mostly “people who are pretty frustrated individuals who have had problems” with the federal website.

“We can try to answer their questions and help them through the process, but they still have to go back to that site to complete the process,” Stock said.

He added, “I would say that things are going 100 percent better today than they were going in October, but the entire process and the entire rollout has still been woefully poor.”SMALL BUSINESS PROGRAM

Joe Childers, an insurance agent with Watershed Benefits in Maumelle, said he and his business partner, Eric Townsend, have helped about 100 people covered by ARHealthNetworks find other coverage, either through the federal website or a state website, access.arkansas.gov, that allows people to apply for coverage in the state’s expanded Medicaid program.

The applications of about 100 others, he said, were still pending as of late last week.

While some people are able to complete their enrollments in one session, others must submit documents to verify their identities or incomes.

In one case, he said, a woman who attempted to enroll last week was asked to send a copy of her driver’s license to the Centers for Medicare and Medicaid Services and was told to allow two to three weeks for processing.

He added that some people once covered by ARHealthNetworks decided not to enroll in plans on the exchange because the premiums would be too high, even after subsidies were applied.

“The reality is, for a lot of these HealthNet people, when you get into the $80-$100 range, it’s too much,” Childers said. “They can’t afford it.”

Created in 2006, ARHealthNetworks offered limited health benefits to small-business employees and their spouses, as well as self-employed individuals with incomes of up to 200 percent of the poverty leveland their spouses.

Those with incomes of up to 200 percent of the poverty level - all but 1,500 of the 19,800 people enrolled - paid monthly premiums of $25. Others paid $275 a month.

Under the expansion of Medicaid approved by the state Legislature this year, adults with incomes of up to 138 percent of the poverty level - $15,860 for an individual or $32,500 for a family of four - will qualify for more comprehensive coverage.

Most of the 250,000 people who became eligible for Medicaid through the expansion can sign up for private plans on Arkansas’ exchange, with Medicaid paying the full premium and eliminating or reducing their out-of-pocket costs for medical care.

About 10 percent are expected to be assigned to the traditional Medicaid program because they are considered to have exceptional health needs.

Whether enrolling in the traditional program or private plans under the so-called private option, those who qualify for Medicaid won’t have a coverage gap because the program will cover up to three months of medical expenses after enrollment.

Those who are losing their coverage on Dec. 31 and don’t qualify for Medicaid must sign up for other coverage by Monday to avoid having a gap.

If they sign up for plans on the exchange and have incomes of less than 400 percent of the federal poverty level, they can qualify for federal tax credits to cover some or all of their premiums. Theincome threshold for the tax credits is $45,960 for an individual or $94,200 for a family of four.

Applications for the tax-credit assistance or Medicaid coverage can be submitted to the Centers for Medicare and Medicaid Services through healthcare.gov, by calling a federal call center at (800) 318-2596 or by submitting a paper application to the federal agency.

Medicaid applications also can be submitted through the state website, access.arkansas.gov, by calling a state call center at (855) 372-1084 or by submitting a paper application to the Arkansas Department of Human Services.

Kate Luck, a spokesman for the department, said the department is able to determine the eligibility of about half of the people who apply through the state website by checking the information submitted against records in a federal data hub.

Other applicants are required to submit documentation, such as pay stubs, to a processing center in Pine Bluff, she said.

Once eligibility is determined, the applicant is directed to another state website, insureark.org, to complete enrollment.

Luck said Medicaid officials discussed extending the ARHealthNetworks past Dec. 31, but ultimately decided that applicants would have enough time to find other coverage.

Christina Basham, owner of Boulevard Bread Co. in Little Rock, said Childers and Townsend helped about seven of her employees who are covered by ARHealthNetworks enroll in other coverage earlier this month. About five others, however “decided they were just going to do it on their own.”

Among those who enrolled with the insurance agents’ help, “the feedback that I have had has been pretty positive,” Basham said.

“They didn’t have any problems, and they got signed up.” HIGH-RISK POOLS

Act 713, passed by the Legislature this year, requires the state’s Comprehensive Health Insurance Pool, which covers about 2,400 people, to end Dec. 31.

The insurance program was created in 1995 to provide coverage for people whose health conditions prevented them from being able to buy insurance in the private insurance market.

Under the federal healthcare law, insurance companies will not be able to deny coverage to people or charge them more for their health conditions for coverage starting Jan. 1 or later.

Earlier this month, U.S. Health and Human Services Secretary Kathleen Sebelius announced that a similar federal program, which also had been set to end Dec. 31, will be extended to Jan. 31 to give those enrolled, including about 700 Arkansans, more time to find other coverage.

Extending the state program would require a special session of the Legislature, said Chuck Cliett, an attorney for the program.

He added that most of the 2,400 who are covered by the state program would not qualify for federal subsidies. State law required premiums for the state insurance program to be about 50 percent higher than the average premium available on the individual insurance market.

Those who don’t qualify for federal subsidies don’t need to use the federal website to sign up for coverage. Instead, they could enroll directly through an insurance company.

Among those covered by the state program is Carla Koen, a 46-year-old former Arkansas Democrat-Gazette copy editor who was among the survivors of the 1999 crash in Little Rock of American Airlines Flight 1420.

After numerous unsuccessful attempts, Koen, now an office manager for a Little Rock development company, said she created an account on healthcare.gov in early November. Even after that, however, comparing the different features of the plans on the site was difficult.

“A lot of the things I was clicking on were sending me to an error page,” she said.

Then, on Tuesday, she said, “the stars aligned.”

After being able to compare the details of the plans without landing on an error message, she chose a plan offered by Arkansas Blue Cross and Blue Shield.

Koen, who doesn’t qualify for an income-based subsidy, will pay a monthly premium of about $395, compared with the $300 she had been paying under the state program. But her deductible will be lower - $1,000 as compared with $10,000 for her plan in the state program.

“I could stand to save thousands if I have a year next year like I had this year,” she said.

PRIVATE PLANS

St. Louis-based Centene Corp.’s Celtic Insurance Co., which had policies covering 288 people in the individual market at the end of last year, and Hartford, Conn.-based Aetna Inc.’s Coventry Health Care, which covered 41 people, have notified the Arkansas Insurance Department that they will terminate their customers’ policies by the end of this year because of new requirements under the federal health-care law that take effect Jan. 1.

Those customers will be offered new policies that meet the health law’s requirements, including offering certain benefits and covering people regardless of their medical conditions.

In addition, Bedford Park, Ill.-based United Security Life and Health Insurance Co. notified its customers in late September that it is leaving the Arkansas market and terminating its plans in the state as of March 31.

The company’s policies covered 275 Arkansans at the end of last year, according to the Insurance Department.

According to the department, the state’s other insurers, covering about 120,000 people, gave existing customers in the individual market the option to renew their policies for at least another year.

Robin Fletcher, an insurance agent with The Hatcher Agency in Little Rock, said most of the firm’s 1,000 clients with individual health policies decided to renew, rather than sign up for a plan on the exchange.

But, she said, she had been busy last week helping people whose coverage under ARHealthNetworks or the Comprehensive Health Insurance Pool will end.

For the most part, people were able to enroll through healthcare.gov, which she called a “huge improvement” compared with two months earlier.

“We are constantly working,” she said.

Front Section, Pages 1 on 12/22/2013

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