By Ann McCreary
The second round of open enrollment through Washington’s online health insurance marketplace begins Saturday (Nov. 15), providing residents a chance to renew or purchase health insurance for 2015.
The enrollment period extends through Feb. 15, but people who want coverage to begin Jan. 1 must select a plan on Washington Healthplanfinder and pay by Dec. 23.
Customers who struggled during last year’s rocky debut of the state’s health insurance exchange, created under the Affordable Care Act (ACA), will likely find the process somewhat easier this year, predicts Lori Valentine of Room One in Twisp.
“They’ve worked out some of the quirks. And there are more resources for us,” said Valentine, who is trained as a “navigator” to assist people in signing up for insurance.
Like last year, Room One has two trained navigators to provide help to Methow Valley residents with the process of enrolling for qualified health insurance plans and determining if they qualify for financial assistance through subsidies or tax credits to pay for their plans.
As required by the ACA (sometimes called Obamacare), qualified plans cover 10 essential benefits including doctor and emergency room visits; hospital stays; prenatal care; mental health and substance abuse services; prescription drugs; services and devices to help in recovering from injury, disability or chronic conditions; lab tests; preventive services; management of chronic diseases like asthma or diabetes; and pediatric services including dental and vision care.
The ACA also prohibits insurance companies from denying coverage to people who are sick or who have chronic conditions, and from cutting off their insurance when they get sick.
This year, more insurance companies are offering more plans in Washington from which consumers can select coverage. In Okanogan County the number of insurance companies offering plans for 2015 has increased from three to five.
Consumers, navigators and insurance brokers will have to wait until Saturday, however, to see the details of those plans because they won’t be displayed on the Healthplanfinder website until then.
“We don’t get to see the site until enrollment actually opens,” said Valentine. “We don’t get to see the new plans until then.”
Under state law, navigators can provide technical assistance to help people sign up for insurance, but are not allowed to make personal recommendations regarding selecting plans to clients. “Once they get to a point where they need [advice] to pick a plan, we refer to brokers,” Valentine said.
“I wish the exchange would have made the plans available before the 15th,” said Jeff Lindstrom, a Seattle-area broker who has worked with Room One clients referred by the navigators.
Not allowing people to evaluate plans before enrollment begins “really did a disservice to consumers,” Lindstrom said.
“They [Health Benefit Exchange] are creating their own crush,” he said. “You put people in a funnel called open enrollment to renew or choose a new plan and you don’t give people any information ahead of time to do so. It’s very hard to help clients make good decisions all at once.”
Since last fall’s first enrollment period, the state Health Benefit Exchange, which operates the Healthplanfinder website, has taken steps to debug the process that resulted in system crashes, error codes that plagued the application process, and a customer support center that was overwhelmed and unresponsive to the thousands of calls flooding it.
More than 500 customer support representatives will be available at 8 a.m. Saturday to respond to questions, according to the exchange. That’s about five times the number of support staff last year. The support line is 1-855-WAFINDER (1-855-923-4633).
“I plan to bring Tylenol to work with me Saturday,” said one support staff member this week.
Like navigators, customer support representatives are only allowed to provide technical help with enrolling, and are not permitted to give advice on picking a plan, but can refer clients to brokers.
Consumers who need help enrolling or selecting a plan can locate an insurance broker or navigator by ZIP code through a Customer Support link on the Healthplanfinder website. A test of the link found the referrals were very narrow — entering the Winthrop zip code turned up no navigators, although two are located in Room One.
Another new site, www.knowyourplan.org, provides educational videos and information about common insurance terms and issues to consider when selecting a health plan.
Incentives and penalties
Companies offering plans during the last and upcoming enrollment periods include Premera Blue Cross, Community Health Plan of Washington and LifeWise Health Plan of Washington. Moda Health Plan and Molina Healthcare of Washington will also offer plans for 2015.
Consumers can also buy private health insurance directly from insurance companies at any time, but will not be eligible for financial assistance through subsidies or tax credits available through ACA if they do so.
In addition to the incentives to purchase insurance offered by financial assistance, the ACA also provides penalties for people who do not purchase insurance.
People who do not enroll in a health insurance plan in 2015 may be subject to a fine of $325 per individual, or up to two percent of their income, whichever is greater.
As a result of last year’s open enrollment period, the state’s uninsured rate dropped by about 30 percent, according to information from the Health Benefit Exchange. More than 1 million people have enrolled through Healthplanfinder, and 85 percent qualified for free coverage or tax credits to lower their monthly insurance premiums.
Valentine said she has worked with many people through Room One who qualify for Apple Health, Washington’s Medicaid program.
“People are very satisfied that they have insurance and are getting their needs met,” Valentine said. To contact a Room One navigator, call 997-2050.