by Admin. | Mar 11, 2014 | Health Care Reform, Health Exchanges, Individual Exchanges, individual health insurance, Obamacare, State Exchanges
5 Things You Need to Know AFTER Buying Obamacare
How to Enroll on NYS Exchange Marketplace
Congratulations – you just signed up successfully for Obamacare! You made it right before the March 31st deadline and avoided the individual penalty and getting blocked out for 2014. Don’t relax just yet. If you’re one of the many people who applied on the first open enrollment it’s smart to expect some bumps over the next few weeks. Shifting deadlines and technical glitches have left many insurance companies scrambling to catch up to the flood of requests. To make sure you start things right, here are some easy ways to stay vigilant:
- Pay the premium –Until you pay for the plan you do not truly have a plan just yet. Some states and insurance companies have extended the deadline to pay, but its best to do this as soon as possible. For maximum peace of mind, get written confirmation from your new insurance company. If you go to the doctor before you pay your premium, you may end up footing that medical bill if the insurance company doesn’t have a record of your premium payment.
- Member ID Cards –in about 1–2 weeks after you receive your first bill you will receive your Member ID card from your carrier after you’ve made your first premium payment. This is the card you’ll share with medical providers and pharmacies when you receive service. Your carrier may allow you to print a temporary ID card if you need care prior to receiving your Member ID card(s). Your insurance card will (hopefully) arrive in your mailbox in early January. You’ll present it wherever you need services: at the pharmacy, doctor’s office or hospital. Since insurance companies had a very short turnaround time to process new members, you may see a delay. Don’t panic! Go to the insurance company’s website to see if you can print a temporary ID card. (This is a lifesaver!) If you turn up empty, call the company’s customer service number to confirm that you are in their system as an enrolled member.
- Don’t rush to the doctors – If you have an immediate need for a prescription or an appointment, by all means take care of it asap. But if you can, wait a few weeks before scheduling your doctor’s visit. This will give time for the insurance companies and doctors to update their systems with all the new plans and enrollees. This way, you help ensure that the medical claim for your doctor’s visit will be processed accurately – and that you dodge some of the early-stage craziness.
- Double check – that your doctor is in your new plan’s network . Most of the new insurance plans also came with new provider networks. Its smart to double check that your favorite doctor is in the network for the exact plan you just enrolled in. There are specific networks for different insurance products, so make sure you are checking the right one. If your doctor is not in the network, keep in mind that you may have to pay significantly more money to see an out-of-network doctor, so you may consider switching. See States Pushing Back Against Smaller Networks
- Keep records – Keep a record of your payments, calls, emails with your insurance company and physicians. Just in case of a technical glitch in the insurance or doctor’s computer systems, you can show evidence of your payment or confirmations from your insurance company.
Obamacare 2014 Deadline Nearing. You are now more knowledgable than most after reading this article. Given all the new changes thanks to the new insurance plans, new enrollees, and changing deadlines, being aware of these simple tips will help you avoid unnecessary headaches. And remember, if you are still shopping for insurance, you only have until March 31st to enroll in a plan.
For enrollment help before the deadline information please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Resource:
![FAQ Health Care Reform Exchange Marketplace Health Exchange FAQ](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/Health-Exchange-FAQ.tiff)
- Click Above
Federal government health care site: www.healthcare.gov
Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx
by Admin. | Feb 3, 2014 | Health Care Reform, Health Exchanges, Individual Exchanges, PPACA, SHOP Exchanges, State Exchanges
Licensed Brokers vs Navigators
With less than 45 days before the first Affordable Care Act Open Enrollment set to end its important to understand the role of both Brokers and Navigators. The Patient Protection and Affordable Care Act (PPACA) requires States to establish a “Navigator” Program to help educate consumers about Health Exchange marketplace. With the new health insurance exchanges a broker can act either as a traditional broker or a navigator (but not both). The info-graph below illustrates how navigators will differ from brokers.
Specifically, agents and brokers play a vital role in the developing health insurance exchanges nation wide. As the individuals with the education and expertise to advise and help select health insurance products for families and businesses large and small, health insurance agents, brokers and consultants occupy a unique place in the health care coverage system.
We educate consumers on their health care coverage choices, help them select the most appropriate plans for their specific needs, and serve as their advocate if problems should arise. Subject to strict state licensing laws and education requirements, agents, brokers and consultants are critical to not only the health insurance enrollment process, but also in serving the healthinsurance coverage needs of individuals and employers after the point of sale.
Benefit specialists design benefit plans, explain coordination issues of public and private benefits to individuals and employees, and solve complex claims and billing issues. We help design and implement cutting-edge health promotion and wellness programs and help our clients comply with state and federal laws like newly enacted PPACA, HIPAA, COBRA and ERISA.
Professional agents, brokers and consultants continue to assist individuals and small businesses with their coverage needs long after the point of sale. Whereas a travel agent is finished with a client after the travel is completed, benefit specialists continues to serve as compliance experts, health and wellness promoters and the prominent contact for complex claims and billing issues. Health insurance coverage is a longstanding commitment for American consumers and often requires guidance from benefit specialists when dealing with a complex healthcare system.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
by Admin. | Jan 28, 2014 | Health Care Reform, Health Exchanges, Individual Exchanges, PPACA, SHOP Exchanges, State Exchanges
States Pushing Back Against Smaller Networks
From Kaiser Health News:
Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs.
The plans don’t start offering coverage until January but they’re facing regulatory action, possible legislation, and in at least one case involving a high-profile children’s hospital, litigation.
The pushback against “narrow” provider networks recalls the backlash against managed care and health maintenance organizations in the 1990s. Protests from consumers and hospitals eroded those attempts to restrain expenses by narrowing provider networks.
Now criticism of limited networks has risen as consumers realize that, despite President Barack Obama’s pledge that they could keep their doctors, their Affordable Care Act insurance may not include the physicians or hospitals they’ve been seeing.
The critique feeds into the politically damaging outcry over the millions of people whose health plans were cancelled. It’s unclear whether the limited choice of doctors and other providers will be as much of a concern to uninsured people who will be gaining subsidized coverage through the state-based marketplaces.
Still regulators and elected officials in a few states have already forced changes. Others are weighing legislation that could expand the networks. Legal fights are brewing. In some cases, the officials are responding to complaints of health care systems or providers that were excluded.
In Maine, state regulators prohibited Anthem BlueCross BlueShield from switching some customers to a network sold through the Affordable Care Act’s marketplace that excluded six of the state’s hospitals.
In Washington State, the insurance commissioner initially banned several health plans from the online exchange for what he called inadequate caregiver networks. Some of the plans have broadened networks; the dispute continues with others.
In New Hampshire Anthem’s 2014 marketplace plans exclude more than a third of the state’s hospitals. Lawmakers have written legislation that would force insurers to expand choice.
Anthem will “use the excuse, ‘Well, we’re going to save money by having a narrow network,’” said State Rep. Bill Nelson, a Republican who sponsored the bill pendingin the New Hampshire legislature. “Sure that could happen for some people, but other people are going to be losers. Imagine having to change the doctor you’ve had for years.”
South Dakota, Pennsylvania and Mississippi are discussing measures similar to Nelson’s, known as “any-willing-provider” laws that would force insurers to accept more participants in the networks.
Broader choice comes with a price. The ability to sell less-expensive plans with limited choices of doctors and hospitals helps contain medical inflation, health economists argue. Looser networks could. mean higher prices.
“We had narrow networks in the ‘90s. Health-care prices not only moderated, but actually there was one year where they fell,” said Northwestern University professor David Dranove, who specializes in the health care industry. “Then we had the HMO backlash and we had broad networks [again], and health care prices went through the roof.”
In a typical narrow network, offered in many states under the new ACA rules, caregivers agree to lower prices in expectation of more patients. Insurers pass some of the savings to consumers. Done correctly, limited networks can also save money because family doctors, specialists and hospitals who are all part of the same network do a better job of coordinating care, many health policy experts believe.
Excluding certain hospitals from Anthem’s New Hampshire narrow plan would allow premiums to be 25 percent lower than they otherwise would have been, a company spokesman said. Anthem’s narrow Maine plan would save 12 percent, he said.
Insurers are supposed to compete side-by-side in the health law’s subsidized, online exchanges. Under the ACA, they must all now offer certain basic health benefits and they must cover anyone, regardless of pre-existing conditions.
On this new legal terrain, they compete by offering their best combination of price and providers directly to individuals and families who lack other coverage. Adjusting caregiver rosters is one of the few remaining ways insurers can lower costs, limited-network advocates say.
But others argue that these narrow networks can force patients to switch doctors or drive long distances for care if a key hospital is left out of the plan, especially in states such as Maine and New Hampshire with few insurers selling through the ACA marketplace.
“Whenever you have an extremely narrow network there are potential problems for patients with cancer and for patients with any chronic condition, particularly when it requires the patient to go out of network,” said Kirsten Sloan, senior director of policy for the American Cancer Society Cancer Action Network.
Leaving a network to seek specialized care can lead to enormous out-of-pocket bills, she said.
In extreme cases networks could be too small to serve all the plan members they sign up.
“It’s no good making a narrow network that nobody can get in to see,” said Sander Domaszewicz, a senior benefits consultant at Mercer.
Insurers began unveiling ACA marketplace plans with narrow networks in recent months for coverage that starts in January 2014. Policymakers soon challenged them in several states, often pushed by excluded hospitals and their patients.
Maine Insurance Superintendent Eric Cioppa blocked Anthem from switching several thousand existing subscribers to a plan that excluded Central Maine Medical Center and partner doctors and hospitals. Anthem argued that shrinking its network would provide less-expensive but still high-quality care.
This summer Washington Insurance Commissioner Mike Kreidler blocked five insurers from selling through the exchange, in several cases because of network problems. One plan, he said, would have required people to drive nearly 50 miles to see a cardiologist and more than 100 miles to see a gastroenterologist.
Four plans protested Kreidler’s ban. Three reached settlements, some by adjusting networks. An administrative judge ruled in favor of another, Coordinated Care, whose network doesn’t include a children’s hospital.
Seattle Children’s Hospital, left out of networks including Coordinated Care’s, then sued Kreidler, alleging he failed to ensure adequate access to care.
In New Hampshire, Anthem’s decision to leave hospitals out of its network has prompted at least one to threaten litigation, and Nelson to introduce his bill. Anthem’s network could force some patients in his district to drive a dozen of miles or more to get routine care, he said
In few places has the fight over networks been fiercer than in Mississippi. BlueCross Blue Shield of Mississippi cancelled in-network contracts over the summer with Health Management Associates, a for-profit chain with 10 hospitals in the state.
Blue Cross isn’t selling insurance in 2014 through Mississippi’s federally run ACA marketplace, but many expect it to come on board later.
In response HMA took to the airwaves in protest and pitted the insurance commissioner, who wanted only four hospitals reinstated, against the governor, who ordered the insurer to take back all 10.
“I’ve been practicing law for 36 years and I have never seen as aggressive an effort to sway public opinion as these guys engaged in,” said David Kaufman, an outside lawyer for BlueCross BlueShield of Mississippi said of the hospital chain. “You could not go to your mailbox, pick up a newspaper, watch TV, listen to the radio or answer your home phone without hearing that Blue Cross is the devil.”
Blue Cross sued Gov. Phil Bryant, arguing the order was unconstitutional, noting that his daughter works for HMA’s law firm and pointing out that HMA is one of his top campaign contributors. Bryant backed off but ordered Insurance Commissioner Mike Chaney to hold hearings. He refused. Bryant and Cheney, both Republicans, have clashed repeatedly over the federal health law.
Now Mississippi, too, is talking about an any-willing-provider law, which typically requires insurers to take any hospital, clinic or doctor under terms accepted by other participants.
Such a rule would tell Blue Cross that “it can’t kick somebody out of the hospital of their choice,” HMA executive Paul Hurst told WFMN radio’s Paul Gallo on a show broadcast statewide.
But in any state, making every insurer accept every hospital, “is going to throttle competition,” said Dranove, the Northwestern professor who specializes in the health industry. “And this is a healthcare reform that depends entirely on competition. So the people who are fighting for broad networks… are ultimately fighting for the demise of Obamacare.”
Millennium Medical Solutions Inc. will continue to monitor and report on narrow net- work plans and other efforts by insurers to control costs in the PPACA environment.
by Admin. | Dec 10, 2013 | Health Care Reform, Health Exchanges, Individual Exchanges, individual health insurance, SHOP Exchanges, State Exchanges
![Health Exchange](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/images-5-300x106.jpeg)
![NYS of Health Screen Shot](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/12/NYS-of-Health-image-Dec-2013-300x101.jpg)
NYS Health Exchange 100,000 Enrolled. According to a USA Today article More than 100,000 enroll in N.Y. health exchange, up a third in less than two weeks according to the state Health Department .
According to the NYS Exchange site www.nystateofhealth.ny.gov– As of today, 100,881 state residents had enrolled in a health insurance plan through the state’s exchange. Additionally, 314,146 people had “completed applications” for coverage. The state did not break down the latest data based on the number of people enrolling in private insurance versus Medicaid. The state’s already “vast” Medicaid system “has been credited with having an easier transition to the health exchange.” New York state plans to enroll a total of 1.1 million people by the end of 2016
New York already has a vast Medicaid program, at an annual cost of $50 billion, it has been credited with having an easier transition to the health exchange. Reuters reported Dec. 4 that about 29,000 people signed up for health insurance through the federal HealthCare.gov website on Dec. 1 and Dec. 2 – eclipsing the 26,000 for all of October.
According to sources and our experience half of the Exchange applicants were to determined not be Medicaid eligible. The article Federal exchange sends unqualified people to Medicaid points out that some qualified Medicaid may not in fact be eligible. “The federal health care exchange is incorrectly determining that some people are eligible for Medicaid when they clearly are not, leaving them with little chance to get the subsidized insurance they are entitled to as the Dec. 23 deadline for enrollment approaches.”
New York State, unlike 36 states, runs its own exchange. The NYS website has had less issues than the troubled Federal health Exchange www.healthcare.gov. Our blog NYS Approves Health Insurance Exchange Rates describes how the new rates lower individual insurance market by 50%.
New York has various tiers of health insurers, and customers can pick from 16 insurers and 10 dental insurers. Quotes can also be viewed on our site. The program also has a small-business marketplace that offers health insurance to businesses with 50 or fewer employees. Large businesses that do not offer employees health insurance could be hit with a fine in 2015.
The exchange also offers tax credits to those who earn less than $45,960 as an individual or $94,200 as a family of four.People without health insurance would be hit with a fine on their income taxes for 2014, starting at about $95 or 1 percent of gross income. The fine can grow to as much as $695 a year , then double in 2015 and grow over time.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Governor’s Press Release
NYS Approved 2014 Exchange Rates
The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.
- Affinity Health Plan, Inc.
![The cheapest you'll pay for individual health insurance in NY NYS Approves Health Insurance Exchange Rates](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/130717172420-obamacare-nys-620xa-300x166.png)
- American Progressive Life & Health Insurance Company of New York
- Capital District Physicians Health Plan, Inc.
- Health Insurance Plan of Greater New York
- Empire BlueCross BlueShield
- Excellus
- Fidelis Care
- Health Republic
- Healthfirst New York
- HealthNow New York, Inc.
- Independent Health
- MetroPlus Health Plan
- MVP Health Plan, Inc.
- North Shore LIJ
- Oscar Health Insurance Co.
- United Healthcare
Resource:
![FAQ Health Care Reform Exchange Marketplace Health Exchange FAQ](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/Health-Exchange-FAQ.tiff)
- Click Above
Federal government health care site: www.healthcare.gov
Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx
[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Website’ type=’url’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]
by Admin. | Jul 18, 2013 | Health Care Reform, Health Care Refrom, Health Exchanges, Individual Exchanges, NY News, PPACA, SHOP Exchanges, State Exchanges
![Health Exchange Health Insurance Exchange](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/images-5-300x106.jpeg)
NYS Approves Health Insurance Exchange Rates.
Governor Cuomo announced yesterday that New York’s Health Benefits Exchange have been approved . Additionally, the New York Times yesterday published an article highlighting that the rates in the individual market that will be offered in 2014 are at least 50 percent lower than they are now. The article link and Governor’s office press release are included below.
5 things we now know about the NYS Exchanges:
- Importantly, Insurers must still confirm that they will be in either the individual exchange and/ or shop exchange
- The rates approved yesterday are subject to final certification of the insurers’ participation in the exchange.
- Many of the networks used on the Exchange appear to be smaller than the group rated.
- Some new insurers have eneter the marketplace such as OSCAR and Freelancers. While a few such as EmblemHealth have taken a wait and see approach.
- Additionally, NYS individual market rate will drop significantly in 2014 but they have been historically always the highest. An individual/Direct Pay HMO is approximately $1,000-$1,200/month. They are still approximately 18% highest.
The Department of Financial Services (DFS) has approved New York’s Health Health Insurance Exchange rates for 17 insurers seeking to offer coverage including eight new entrants into the market that do not currently offer commercial health insurance plans. Please click the following links for the Governor’s Press Release and the Individual and Small Group rates.
Governor’s Press Release
NYS Approved 2014 Exchange Rates
The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.
- Aetna
- Affinity Health Plan, Inc.
![The cheapest you'll pay for individual health insurance in NY NYS Approves Health Insurance Exchange Rates](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/130717172420-obamacare-nys-620xa-300x166.png)
The cheapest you’ll pay for individual health insurance in NY
- American Progressive Life & Health Insurance Company of New York
- Capital District Physicians Health Plan, Inc.
- Health Insurance Plan of Greater New York
- Empire BlueCross BlueShield
- Excellus
- Fidelis Care
- Freelancers Co-Op
- Healthfirst New York
- HealthNow New York, Inc.
- Independent Health
- MetroPlus Health Plan
- MVP Health Plan, Inc.
- North Shore LIJ
- Oscar Health Insurance Co.
- United Healthcare
If you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you please contact our team at Millennium Medical Solutions Corp. Stay tuned for updates as more information gets released. We’re inside of 75 days until exchanges open, and information will be coming quickly in the next few months. Sign up for latest news updates.
Resource:
![FAQ Health Care Reform Exchange Marketplace Health Exchange FAQ](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/Health-Exchange-FAQ.tiff)
Click Above
Federal government health care site: www.healthcare.gov
Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx
[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Website’ type=’url’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]
by Admin. | Jul 2, 2013 | Health Care Reform, Health Exchanges, individual health insurance, MEDICARE, Obamacare, State Exchanges
Obamacare 1.0: Rolling Brown Outs?
The sheer technological volume of it all could bring “rolling brown outs” similar to electrical grids. Try to imagine a scenario of credit union Experien working with IRS then Social Security & Center for Medicare & Medicaid Services’s dated mainframe computer system while balancing HIPAA and privacy sensitive information. All this while millions of people converge simultaneously onto the information highway. Visualize all of the U.S. Daily Commuters driving into Manhattan today.
As reported below by Reuters’ Sharon Begley Obamacare 1.0: States brace for Web barrage when reform goes live: “Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.”
By Sharon Begley
NEW YORK | Sun Jun 30, 2013 7:03am EDT
(Reuters) – About 550,000 people in Oregon do not have health insurance, and Aaron Karjala is confident the state’s new online insurance exchange will be able to accommodate them when enrollment under President Barack Obama’s healthcare reform begins on October 1.
What Karjala, the chief information officer at “Cover Oregon,” does worry about, however, is what will happen if the entire population of Oregon – 3.9 million – logs on that day “just to check it out,” he said. Or if millions of curious souls elsewhere, wondering if Oregon’s insurance offerings are better than their states’, log on, causing Cover Oregon to crash in a blur of spinning hourglasses and color wheels and an epidemic of frozen screens.
Multiply that by another 49 states and the District of Columbia, all of which will open health insurance exchanges under “Obamacare” that same day, and you get some idea of what could go publicly and disastrously wrong.
Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.
Although IT is the single most expensive ingredient of the exchanges, with eight-figure contracts to build them, experts expect bugs, errors and crashes. In April, Obama himself predicted “glitches and bumps” when the exchanges open for business.
“This is a 1.0 implementation,” said Dan Maynard, chief executive of Connecture, a software developer that is providing the shopping and enrollment functions for several states’ insurance exchanges. “From an IT perspective, 1.0’s come out with a lot of defects. Everyone is waiting for something to go wrong.”
Two states that intended to build their own exchanges, Idaho and New Mexico, announced this spring that because of the tight timeline and daunting challenges they would have the federal government operate their IT systems.
“Nothing like this in IT has ever been done to this complexity or scale, and with a timeline that put it behind schedule almost before the ink was dry,” said Rick Howard, research director at the technology advisory firm Gartner.
WHAT COLOR WAS YOUR VOLVO?
The potential for problems will begin as soon as would-be buyers log onto their state exchange. They’ll enter their name, birth date, address and other identifying information. Then comes the first IT handoff: Is this person who she says she is?
To check that, credit bureau Experian will check the answers against its voluminous external databases, which include information from utility companies and banks on people’s spending and other history, and generate questions. The customer will be asked which of several addresses he previously lived at, for example, whether his car has one of several proffered license plate numbers, and what color his old Volvo was.
It’s similar to the system that verifies identity for accessing personal Social Security information. If someone gets a question wrong, he will be referred to Experian’s help desk, and if that fails may be asked to submit documentation to prove he is who he claims to be.
The next step is determining if the customer is eligible for federal subsidies to pay for insurance. She is if she is a citizen and her income, which she will enter, is less than four times the federal poverty level. To verify this, the exchange pings the “federal data services hub,” which is being built by Quality Software Services Inc under a $58 million contract with the Centers for Medicare & Medicaid Services (CMS).
The query arrives at the hub, which does not actually store information, and is routed to online servers at the Internal Revenue Service for income verification and at the Department of Homeland Security for a citizenship check.
The answers must be returned in real time, before the would-be buyer loses patience and logs off. If the reported income doesn’t match the IRS’s records, the applicant may have to submit pay stubs.
These federal computer systems have never been connected before, so it’s anyone’s guess how well they’ll communicate.
“The challenge for states,” said Jinnifer Wattum, director of Eligibility and Exchange Solutions at Xerox’s government healthcare unit, is that they have to build “the interfaces needed with the federal data services hub without knowing what this system will look like.” That makes the task akin to making a key for a lock that doesn’t exist yet.
CMS’s contractors are working to finish the hub, but “much remains to be accomplished within a relatively short amount of time,” concluded a report from the Government Accountability Office (GAO), the investigative arm of Congress, in June. CMS spokesman Brian Cook said the hub would be ready by September, and that the beta version had been tested for its ability to interact with the exchanges Oregon and Maryland are building.
The federal hub has to verify even more arcane data, such as whether the insurance offered to a buyer through his job is unaffordable, in which case he may qualify for federal subsidies, and whether the buyer is in prison, in which case she is exempt from the mandate to purchase insurance.
If someone’s income qualifies him for Medicaid, or his children for the Children’s Health Insurance Program (CHIP), software has to divert him from the ACA exchange and into those systems. Many of the computers handling Medicaid and CHIP enrollment are, as IT people diplomatically put it, “legacy systems,” meaning old, even decades old.
Many are mainframes, lacking the connectivity of cloud computing. They typically process eligibility requests in days, not seconds.
The legacy systems “rely on daily or weekly batch files to pass information back and forth,” and often require follow-up phone calls, said Wattum of Xerox, which is working to configure Nevada’s exchange so it can interface with the federal hub.
‘NO WRONG DOOR’
A “we’ll call you” message is unacceptable under Obamacare, which has a “no wrong door” goal: A buyer must never come to a dead end. If she is diverted to Medicaid, for instance, she must not be required to resubmit information, let alone wait a week for an answer about whether she’s now enrolled.
State IT systems must therefore “be interoperable and integrated with an exchange, Medicaid, and CHIP to allow consumers to easily switch from private insurance to Medicaid and CHIP,” said an April report from the Government Accountability Office (GAO), the investigative arm of Congress.
To make all those systems communicate, the state exchanges must either develop entirely new systems or use application programming interfaces (APIs) that work with the legacy systems to exchange data in real time. APIs are programming instructions for accessing Web-based software applications.
GAO’s Stan Czerwinski compares the necessary connectivity to adapters that let Americanelectronics work with European outlets.
State officials told the GAO that verifying eligibility, enrolling buyers and interfacing with legacy systems are the most “onerous” aspects of developing their exchanges, “given the age and limited functionality of current state systems.”
A key goal for exchange officials is keeping would-be buyers in the portal so they don’t give up and use a state’s ACA call center, which could quickly be swamped.
To avoid this, Oregon brought in potential users to test design prototypes, recorded what people did and where they had trouble, and tweaked the consumer interface to make it as user-friendly as possible, said Karjala.
“Even with that, if you have a family of four and you’re eligible for a tax credit to offset your premium,” he said, “you could be sitting at the computer for a long time.”
What everyone hopes to avoid is a repeat of the early days of the Medicare prescription-drug program in 2006. Some seniors who tried to sign up for a plan were mistakenly enrolled in several, while others had the wrong premium amounts deducted from their Social Security checks.
Another challenge is capacity. Websites regularly crash when too many people try to access them.
“I had no choice but to be extremely conservative” in estimates of how many simultaneous users Cover Oregon has to be prepared for, Karjala said. “Building capacity is the only way to avoid the spinning hourglass or the site freezing, so in our performance testing we’re seeing what happens if the whole U.S. population came to Cover Oregon to check it out.”
This summer, state exchanges will test their ability to communicate with the federal data hub, whose security frameworks and connectivity protocols are still works in progress. But whether Obamacare 1.0 flies won’t be known until the new health plans take effect on January 1. Robert Laszewski, president of Health Policy and Strategy Associates Inc, a consulting firm, said he wouldn’t be surprised if some patients showing up at doctors’ offices next year with Obamacare policies are told their insurers never heard of them.
(Additional reporting by Caroline Humer; Editing by Michele Gershberg and Prudence Crowther)