Health marketplace coverage begins today

Health Care Marketplace Enrollment

Source: U.S. Department of Health and Human Services

Benefits kick in today for thousands of Ohioans enrolled in private health plans through federal marketplaces created by the Affordable Care Act.

But before you call for a doctor’s appointment, government officials advise anyone who applied for coverage through the HealthCare.gov website first to call their insurance company to confirm their enrollment and get an insurance card or a temporary card for proof of coverage.

While most of the technical problems that plagued the website after its initial launch last October have been resolved, government officials acknowledge they are still working to ensure that accurate and complete data is being passed along to insurers from the website — the main portal for enrollment in marketplaces in 36 states, including Ohio.

“For consumers whose marketplace coverage begins on Jan. 1, we’re doing everything we can to help ensure a smooth transition period,” U.S. Secretary of Health and Human Services Kathleen Sebelius said Tuesday. “If consumers have questions about their new private insurance coverage, they can contact their insurance company directly.”

If insurers do not receive complete and accurate data from applications processed through the federal website they have no way of verifying those customers accounts, which could lead to problems when policyholders try to use their new benefits, experts say.

But at least one Ohio insurer was working feverishly to make sure people who signed up for one of their marketplace plans by the Dec. 24 deadline would have coverage on New Year’s Day.

“Medical Mutual has been fielding a large volume of calls from consumers who wish to verify their health insurance coverage is effective Jan. 1, 2014,” the Cleveland-based insurer said Tuesday in a response to the Dayton Daily News. “We are verifying their coverage status through our membership files that are updated with electronic enrollment data Medical Mutual receives daily from the federal government. If we don’t have any record of the consumer’s marketplace application, we are instructing them to contact HealthCare.gov to determine if their information was processed.”

A flood of sign-ups on the federal website on the day before Christmas Eve put pressure on the government to process a mass of new enrollees by the first of the year.

Of the 1.1 million people enrolled in private insurance plans through the federal health care marketplace, more than 975,000 Americans signed up in December, the Obama administration said Sunday.

Combined with numbers for state-run markets, total enrollment has reached 2.1 million people, Sebelius said.

“I figured at some point they would get the bugs out of the (HealthCare.gov) website, so I’m not surprised by the numbers,” said Gregg Hopkins, executive director of Community Health Centers of Greater Dayton, which has assisted with marketplace enrollment in the local area. “Even though it was met with technical problems and political push-back, we knew it was best for our clients and our patients, and they responded.”

Opponents of the health care law are quick to point out that enrollment still falls well short of the government’s goal of enrolling 3.3 million Americans in marketplace plans by the beginning of the year, and, they say, the latest figures were mainly the result of the government repeatedly extending the deadline for enrollment.

The original deadline for coverage beginning today was extended from Dec. 15 to Dec. 23, and then to Christmas Eve after HealthCare.gov proved almost completely dysfunctional in October and November — the first two months of a six-month enrollment period. Anyone signing up for a marketplace plan between now and March 31 will have coverage beginning no sooner than Feb. 1.

“On Oct. 1, just six people across the entire country signed up for coverage through the federal exchange,” said Lt. Gov. Mary Taylor, who also is director of the Ohio Department of Insurance. “Since then, HealthCare.gov has changed, but the website is not the reason why consumers still face higher premiums and less choice. The overall impacts of Obamacare are hurting enrollment, which is why the administration is constantly changing the rules and moving deadlines in an attempt to make the law less harmful.”

Still, there is no denying participation in Ohio’s marketplace has accelerated.

In November alone, 4,522 Ohioans had selected marketplace plans compared to 1,150 in the previous month, according to the most recent state figures.

Kev Coleman, head of data and research at HealthPocket, said it’s important for new customers not only to confirm their coverage but also review their plans to make sure they understand the costs.

While many marketplace policyholders are eligible for tax credit subsidies to defer the cost of premiums, many marketplace plans have deductibles well over $2,000, or about twice the average deductible for job-based coverage. In addition, most marketplace plans have narrower networks of doctors and hospitals to serve new customers than employer-sponsored plans, Coleman explained.

“Consumers should confirm a health care provider’s participation in a health plan network prior to service since out-of-network providers can cost more and also do not have limits on annual out-of-pocket costs,” he said.