The Edmond Sun

January 15, 2014

Enrollees for health care sparse

James Coburn
The Edmond Sun

EDMOND — Youthful applicants are not enrolling for health insurance under the Affordable Care Act (ACA) for what is needed to sustain the rates, said Wayne Pettigrew, a senior consultant with Group & Pension Planners Inc.

Pettigrew spoke this week to members of the Edmond Area Chamber of Commerce about the pros and cons of the ACA.

“They’ve had about 23 percent of the people that have enrolled be under the age of 35,” Pettigrew said. “They expected that to be about 54 percent because that’s where most of where the uninsured were at,” he said.

Another problem is that insurance proving coverage are not always receiving the application when individuals enroll at healthcare.gov and send the data, Pettigrew said.

“They are called phantom apps, and I think they said the other day that 70 percent of the (applications) are not being received by insurance companies,” Pettigrew said.

The site data security of the website is also problematic, Pettigrew said. This is because healthcare.gov was primarily created to capture data instead of enrolling people.

Enrollees can also apply for health insurance by using an insurance agent. The process that will take about 30 days, Pettigrew said.

“I set up a fake name and an old email address and it took me six days to get on back in October,” he said. “I had to shut that email down because I was getting more than 600 emails a day to that email address and they were being forwarded onto my phone.” Most of the emails were solicitations for health care coverage, he said.

 Improvements to the federal health care exchange in December brought 1.1 million more health insurance consumers to the market place, according to the White House.

“More than half a million Americans have enrolled through healthcare.gov in the first three weeks of December alone,” Obama said.

This did not include expanding Medicaid coverage and ACA enrollments due to state-based exchanges. Enrollment surged in December with more than 2.1 million people enrolled in a private health insurance plan through the federal and state-based exchange marketplaces.

Health care insurance kicked-in for these enrollees Jan. 1. The White House still calls for a projected 7.1 million enrollees by March 31.

“One thing you’re going to notice is if your employee renewed Jan. 1, all your preventive services are covered at 100 percent,” Pettigrew said. “That’s probably one of the good requirements. You go in for health screenings, those are now covered at 100 percent.”

Employers must offer health insurance coverage after a 60-day waiting period instead of 90 days as had previously been the case.

A plan has to meet minimum value for coverage under the ACA. Many plans that did not meet minimum value had to be scrapped so that adjustments could be made under a new plan.

“It has to pay at least 60 percent of the (health care) cost to be of minimum value,” Pettigrew said.



What to expect on Affordable Care Act in 2014

• Coverage kicks in: Millions of Americans have been signing up — or attempting to sign up — for a health insurance plan since the exchanges opened on Oct. 1. Those people can take advantage of their health plan and the related federal subsidies.

• Individual mandates get real: The mandate is here and if you’re not enrolled in a qualified health plan either via the individual market or through an employer or other group plan by March 1, you can expect a bill for $95 or 1 percent of your income, whichever is higher, to arrive on your doorstep later this year, unless you fall into one of the exception categories.

• Insurance exchanges: In every state must be up and running. Obviously “up and running” is a loose term.

• Insurance subsidies: Premium tax credits and cost-sharing reductions kick-in for those who are eligible.

• Medicaid expansion begins: The Supreme Court ruled to expand the program. As a result, in 2014 as many as 3.9 million more low-income Americans will have access to the public assistance program.  

• Small business tax credit: Small businesses are eligible to apply for a small business tax credit that would help purchase health coverage for their employees. The credit is supposed to expand to more businesses. The “catch” is very few small businesses actually qualify for the credit and now they can only use it to buy Small Business Health Options Program exchange coverage.

• Individuals and businesses: The new national premium tax, which will ultimately be a pass-through fee from the insurer to all consumers of fully-insured individual and group health insurance, goes into effect. The tax will collect $8 billion in 2014, increasing to $14.3 billion in 2018 and increasing based on premium trend thereafter.

• Ninety-day maximum waiting period: This requirement for all employer plans goes into effect.

• Cost-sharing limits: Group health plans, including self-funded plans, may not have out-of-pocket costs that exceed the annual Health Saving Account contribution maximum.

• Annual or lifetime limits are no more.

• Greater wellness discounts: Employers may now offer a discount up to 30 percent for employee participation in a wellness program.

Source: National Association of Health Underwriters