Open Enrollment for the under 65 individual market is officially upon us. As you start to see the increase in leads, emails, voicemails, and paperwork, don’t let your sea of obligations and deadlines keep you from identifying areas of improvement. This open enrollment season take the time (as a broker or an agency) to examine your current Online Benefits Enrollment System technology and processes.

A few questions you should ask yourself:

  • Can we make it through this enrollment year with the technology we currently have and effectively serve our new and existing clients?
  • What technology options exist that address only parts or all of our organizational and customer pain points?
  • What makes sense for us budget-wise; adding one-off software solutions over time or a total replacement technology platform that manages the end-to-end process and administration for us?
As a former broker in both the individual and small/mid group markets, there were many times when I looked at all the pieces and thought, “If I only had an efficient system that could help me manage all these moving parts!” Now I know I’m not the only broker to have said this and had such a system existed at that time, my wish list of functions might have looked something like this:
  1. The ability to quote and write multiple products with multiple carriers in one system, including dental, vision, and voluntary; eliminating the need to go to each carrier to obtain my quotes
  2. A system that created my proposals for me, electronically, in a matter minutes
  3. The ability to help my clients apply for subsidies electronically and in real-time
  4. An online benefits enrollment and administration  that eliminated paper open enrollment packets including paper applications and benefit summaries

As you go through the next two months of OEP and then the Special Enrollment Period, think through your wish list and how your current vendors are stacking up.

If you’re just starting out on your enrollment technology journey we have a quick and easy checklist you can use in those initial conversations. Download here.

For more great insights, connect with me on Linkedin

On March 23, 2010, President Obama signed the Affordable Care Act into a law, putting into motion a series of ups and downs that radically transformed healthcare and health insurance coverage in America. After 5 years of Obamacare operation, we have come far from a fledgling law that saw unequivocal opposition from multiple sources. Today, Obamacare supports 16.4 million enrollees with affordable health coverage through fully functional health insurance marketplaces at federal and state levels. And that’s not the only thing the law is doing for the country.

Of the people who enrolled through marketplaces, almost 87 percent people were able to get premium tax credits and cost sharing subsidies on their health insurance. The millions of dollars put aside by the administration for these subsidies defined the coverage status for families, which could not afford health insurance before. The benefits do not stop there. For people who used to pay thousands of dollars in healthcare for preexisting medical conditions, the ACA worked out to be a saving grace that stopped discrimination against them on the basis of their health. Insurance companies cannot deny people coverage, neither can they charge chronically ill people higher than healthy people. Individual cases where Obamacare literally transformed into a life savior are way too many, and with these subsidies on line, ironically on the 5 year anniversary of the law, the future of the law is uncertain.

State Exchange Lease

The ACA has not forgotten the quality of coverage received by those who utilize their health insurance coverage. Screening for chronic diseases is not chargeable. In fact, some employer-sponsored programs are offering incentives to employees for undergoing routine checkups. The workplace wellness programs are working in favor of employees by offering them a chance to stay healthy at workplace, thereby reducing the healthcare spending by employers, resulting in a win-win situation for both. At the same time, the Obama administration is working with insurance carriers to provide better solutions and offerings through the marketplaces.

Seniors are now paying lesser for their drug costs, and young individuals can stay on their parents’ plan until the age of 26. All these small changes to the way healthcare coverage functions in America are making a huge difference to areas that have traditionally been ignored. As a result, we are moving to a healthier nation, where the health reform is helping people live healthier lives.

However, after these 5 years of Obamacare operation, there still are some issues that need addressing. Some workplace wellness programs have started discriminating against people on the basis of their current health. For instance, overweight people are being assigned weight goals, non-fulfilment of which would result in higher insurance premiums for these employees. This masked form of discrimination is surfacing, and the administration needs to address before it becomes more widespread.

Republicans are targeting the functioning of the law again, and with Congress under their wing, they might do some serious damage to the law. The Supreme Court subsidy challenge is another simultaneous looming challenge that could wreak havoc on the subsidies that connect millions to affordable health coverage. It’s time for the administration to revisit the law and strategize to overcome these potential challenges before they become major hurdles to progress on healthcare.

11 million enrollments and a successful second open enrollment later, the Obama administration should be happy. Enrollment numbers are higher than initial projections, and the signs of a working health reform are omnipresent in the system. Health insurance carriers are adapting to the new marketplace scenario, and are offering better plans at better prices to marketplace shoppers. In addition, citizens are embracing the health insurance marketplace. Collectively, both the providers and shoppers are maturing with the system, and all of this is fueling the success of the ACA.

Out of the shoppers this year, about 4.2 million are returning customers who have revisited the improved marketplace to check their existing plan, weigh available benefits, and upgrade their plans for better benefits. A noteworthy aspect of these shopping trends is the underlying shopper aggression for utilizing market competition to find better health plans with cheaper premiums. Let’s take a look at the behavior of returning and new shoppers, and how they interacted with the marketplace to find the plan that fits their requirements.

The first segment of people is returning customers who automatically reenrolled with their previous plan. Roughly 2 million people chose to stay with their existing plan, and none of them revisited the exchange to weigh available options. Of the remaining shoppers in the 4.2 million returning customers, a little more than half went for new insurance plan this year, while the other segment continued with their existing plan. Nearly 1.2 million people enrolled with a different plan in the second enrollment. While this might not seem like a big number in comparison to the enrolled 11 million, past health insurance industry trends say that this is a pretty big number.

According to CMS, a lot of insured are actively and aggressively seeking better insurance options, and this high number of active consumers is surprising for the health insurance industry. At a preliminary stage, there are two possible reasons why revisiting shoppers looked for new health insurance. The primary reason is cost. Owing to entry of new insurers in the market and adjustment of last year’s premium prices on the basis of available data, a lot of insurance plans offered cheaper health insurance with nearly similar coverage. Another factor that boosted plan switching on cost basis was the subsidy averaging, which considers the cheapest plan available in a consumer’s area while issuing premium tax credits to consumers. So, people who had the option to retain their older plan were likely to be subject to a higher cost as a cheaper plan was available in the region, and the subsidies were to be calculated accordingly. Naturally, a lot of people decided to switch.

The second probable reason for shopping is coverage quality. To retain profitability and market edge, a lot of insurance plans have limited their physician networks. A lot of plans have also included high out of pocket costs. It is possible that a lot of people changed their plans because they wanted access to a wider network or limited burden of deductibles, co-payments and the works. Add the remaining number of 4 million plus people who were using the exchanges for the first time, and you will have considerable shopper movement across the marketplace.

While it is still early to stay exactly what factors contributed to this aggressive shopping surge on the health insurance marketplace, one thing is certain – as the insurers and shoppers mature in the ACA model, a lot of streamlining will automatically happen in terms of coverage options, competitive pricing, and physician networks. Both these forces are still moving to a state of equilibrium, and in the next couple of years, the nature of shoppers will change to reflect that stability. For now, health insurance shoppers are working to make sense of the marketplace and aggressively switching health plans for arriving at their desired combination of price, coverage, and network.

By now, I am sure you must have heard the sounds of celebration in the Obama administration. It has outdone its own enrollment estimate by ending the second enrollment with 11 million enrollments. This open enrollment has seen 11.4 million people re-enroll or enroll for the first time with federal and state-run marketplaces.

Before the open enrollment kicked off on November 15, the HHS set a target range of enrollments at 10.3 million to 11.2 million by February 15. Although the final numbers are not yet published, estimates show that the marketplaces have already crossed that range. In fact, a million people signed up for coverage through the marketplaces in the last 10 days of open enrollment.

Although the three-month period ended on Feb 15, some extensions were provided to people who had initiated but not yet completed their applications in the system. The extension expired on February 22. Some people experienced long wait times for call centers and technical challenges in the last few days due to overload. Other than that, it was a pretty smooth sail for the exchanges this time around.

Out of the 11.4 million enrollments, 8.6 million came from the federal marketplace, which is being used by 37 states. The remaining 13 states and DC managed 2.8 million enrollments, a pretty strong number for the state-run marketplaces. Although the administration did not delve into the details of re-enrollees and first time enrollees, the ratio should be somewhere around 60-40. However, a noteworthy point here is that not all enrollees have paid their first premium, and since that is necessary for qualifying as ‘enrolled’ with the system, it is likely that the number will come down in the next couple of months. A similar trend was noticed last year, when the initial tally was of 8 million enrollments, but these gradually fell down to below 7 million due to policy lapse and switching of health policies. The cancellation of health insurance due to citizenship and other legal matters was another blow to the enrollment numbers.

Since a similar trend could surface this year too, HHS Secretary Sylvia Burwell is thinking of reopening the enrollment period in the tax filing season of April. The administration expects that about 6 million people will learn that they owe penalties while filing taxes and a high percentage of these people might want to buy health insurance instead of paying penalties. This should be announced in a few weeks. Until then, some states, such as Washington, have already extended their enrollment deadline until the end of April.  In 28 states, extensions have been provided to only those people who are not applying for subsidies.

However, amid revelry and a positive outlook resulting from 11.4 million enrollments, the administration and states still need to think that they are far from their goal of a fully insured America. By 2019, there will be at least 30 million uninsured in the country, especially in the 18-34 age range which is choosing to stay away from health insurance due to high costs. There still exists a Medicaid coverage gap that is trapping 5 million people in states, which decided not to expand Medicaid. The SHOP (small business exchange) needs some attention from the administration, as most small businesses are not interested in engaging with the marketplace, choosing instead to offer pay raises to employees who are using the federal marketplace for insurance.

The doctor-patient ratio and the coverage network is another area that needs focus. In the high competition market, several health plans are trying to stay profitable by cutting hospital and physician networks. Couple that with the shortage of primary care physicians and you could have a pretty big issue with appointment availability, etc.

It is clear that other than getting stellar enrollment numbers on the exchange marketplaces, there is a lot that the Obama administration needs to do to retain the ACA momentum. Between this and the looming Supreme Court decision, the future definitely looks challenging.

Completing your tax return this year will be harder for most due to the requirements of the ACA. For the majority of Americans, the process will only require minor changes that can be covered by simply a checkmark on the filing form, nothing more. For others, however, health insurance reporting will require a whole range of forms that cover their insurance coverage status, Premium Tax Credits and reconciliation of availed tax credits with their actual annual income.

Things will be even more convoluted for people who did not have minimum essential coverage for the year. These people will be required to pay penalties under the new setup. Even then, there is a range of conditions attached to what qualifies as ‘minimum essential coverage.

With all these variables, it gets a little hard to move through the process. For ease, I am listing below the 3 paths that checks all Obamacare requirements in your tax filing and guides you through the confusion.

Path #1

This is the simplest path and, fortunately, applies to nearly 80 percent. If you and each member of your family had health insurance throughout the year, then you simply need to check the box titled ‘Full-year coverage’ in one of 1040A, 1040Z, and 1040EZ forms. That’s it. You do not even have to include any proof of insurance as the government should be able to pull that from your records. Done and dusted.

Path #2

This is where it gets trickier. For the 6% of people who bought health insurance off of a marketplace, there are a couple of things to check. File the 8962 form, show the Premium Tax Credits you qualify for according to your annual income and reconcile this number with the tax credits paid toward their health plan in the course of the year. Once you have done that, there are two forks in this path. The first fork will come into play when you made less money than projected or had a life event, such as the addition of a new member to your family, marriage, etc. In that case, entitled premium tax credits will be more than the advance payments made to your health plan, and you will receive the remaining amount as a tax refund.

The second alternative path comes into action when you had more income or fewer family members as noted at the beginning of the year. In that case, you might have to pay some of those tax credits back to the government in your tax filing. For both these alternate sub-paths, you need to use the 8962 form for reconciliation.

Path #3

This is where the penalties come into the picture. If you or any of your dependents did not have health insurance for each month of the year, you will be required to pay penalties. Unless you are exempt from the health insurance penalty, you will have to pay according to the slab you fit in. The penalty ranges from $95 per uninsured adult to $2,448 per uninsured adult, depending upon the family income. On the other hand, if you qualify for exemptions, then you need to have an Exemption Certificate Number that you can submit along with your tax filing.

The ECN has its own share of formalities and processes, and you need to have it handy for completing the filing process. An ECN is available from the marketplace that issued the exemption and is a mandatory document for completing the exemption formalities. This path is the most convoluted of all, with Form 8965 requiring myriad proofs and documents to process your penalties or exemptions.

Among these three paths, you will find that at least one of these leads to complete tax filing. While Path 1 is pretty straightforward, Path 2 and Path 3 can confuse the most seasoned of tax payers. If you are stuck with either second or third, it makes sense to take the help of tax consultants who can help you with forms, procedures, alternatives, and more.

The second open enrollment is underway and people who did not purchase health insurance from the exchanges last time have another opportunity for affordable, quality health insurance coverage. However amid rumors, deadlines and peer pressure, you might be struggling to make sense of all the aspects of the law, especially the subsidies which deliver the primary advantages of Obamacare. Read more

It’s here, the second open enrollment period is in process! It started on November 15 giving Americans another chance at buying affordable health insurance through federal and state-based health insurance exchanges. The second open enrollment period, which goes until February 15, 2015, will allow people to purchase new health insurance or renew older. The SHOP exchange, tailored for the small business market, is also live, and if you work with an organization with 50 or fewer employees, you will have the option of purchasing insurance through this new exchange. Read more

The second open enrollment is finally underway and, unlike last time, the website is working well. The Obama Administration is focused on maximizing enrollments and renewals over the federal and state exchanges from November 15 to February 15t, 2015 and it looks like they are getting results. In 37 states, which chose the federal marketplace to act as their exchange, the enrollment numbers are the opposite of last year. Most of the states, which setup their own exchanges, are posting strong numbers as well. Throughout the first week, some interesting numbers and facts have surfaced. Read more

The second open enrollment period is quickly approaching and the biggest question on everyone’s mind is – how will Obamacare premiums behave in the second year of reformed health insurance coverage? We are roughly two months away from open enrollment and any solid number on rate increase is far from available. As we approach November 15, most health plans across different states will show how premium rates will increase for 2015. However, we are currently limited to projections of how Obamacare will look like in the second year of coverage.
Read more

With health reform surpassing its reach over health insurance to cover tax filing and penalties, Obamacare has brought in new variables this year for a majority of American population. Health insurance coverage or tax penalties, Americans would either have to go with one of these two paths in 2014-2015. For people who did not buy health insurance by the end of Open Enrollment period on March 31, 2014, tax penalties would creep in during tax filing. If you missed the open enrollment period and still want to shield yourself from these tax penalties, you might cover yourself, literally and metaphorically, in the Special Enrollment Period (SEP).
Read more