Sunday, April 22, 2018
Health

Obamacare expects delays in two key marketplaces

Most consumers will be able to shop on the new online insurance marketplaces starting Tuesday, but with days to go before the launch, officials acknowledged that some features will not be ready.

A marketplace for small business owners to seek coverage for employees, and a Spanish-language site both will face delays, officials announced Thursday.

Critics long have pounced on problems in the massive health care law as political fodder, and President Barack Obama struck back firmly on Thursday in a speech at a Maryland college, defending his signature law.

"Like any law, like any big product launch, there are going to be some glitches as this thing unfolds," Obama said. But, he added, "most of the stories you'll hear about how Obamacare can't work is just not based on facts."

Many consumers will need time to learn basic insurance lingo, suss out differences among similar-looking plans and find out if networks include their favorite doctors and hospitals. People have until Dec. 15 to sign up for plans that start Jan. 1, though the initial open enrollment lasts until March 31. Few consumers will be prepared to make a purchase immediately and many are expected to wait until the last minute.

"People don't come into this all at once," said Julie Bataille, a spokeswoman with the Centers for Medicare & Medicaid Services.

On Thursday, the Obama administration said it is delaying enrollment in the Spanish-language marketplace until mid October. And enrollment in a marketplace designed just for small business owners is delayed until Nov. 1. However, both sites are available to examine options.

"We just want to make sure we get it right," said Gary Cohen, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services.

Cohen emphasized that the marketplaces where the largest numbers of people will shop for individual and family coverage are not affected.

The Obamacare marketplaces, also known as exchanges, are geared toward the uninsured and people who can't get affordable coverage through an employer or through Medicare or Medicaid. Individuals and families who earn between 100 and 400 percent of the poverty level ($11,490-$46,000 for an individual) may be eligible for sliding scale subsidies to help pay for the premiums.

If all goes as planned, this is what Floridians should be able to do Tuesday: Create an online account at Healthcare.gov, which will take them to the Florida site. It's being run by the federal government since the state declined to do so. Then shoppers can fill out an application and provide information such as household size, location, expected 2014 income and citizenship status.

With that information, subsidy levels will be determined. Then a list of health plans and their premiums and out-of-pocket costs will be displayed, which consumers can study at length. Once they create accounts, customers can return at any time to pick their plans. When they do, the government will send subsidies directly to the insurer to pay a portion of the premium.

The Obama administration earlier this week released figures showing that average premiums in Florida and 35 other states will be lower than the Congressional Budget Office had originally projected. But key details including the names of the insurers, deductibles and co-pays won't be announced until Tuesday.

The plans are rated from bronze to platinum depending on what portion of average medical costs they cover. But Jon Urbanek, a Florida Blue senior vice president, pointed out that even plans rated the same can be very different.

For instance, one gold plan could have a high deductible and no copay while another gold plan could have the opposite.

In addition to the certified "navigators'' that have drawn the suspicion of Republican leaders, more than 40,000 professional insurance brokers and agents are certified by the federal government to help people through the enrollment process. Humana, for instance, is beefing up its retail centers and co-sponsoring community events where information on the exchanges is available. Florida Blue has nearly doubled its agent workforce in the state and expects heavy traffic in its retail centers.

"We feel like people are just going to want to have that interaction," said Urbanek. "We're going to have a lot of feet in the street."

A plan's network of doctors and hospitals is a huge consideration for insurance shoppers. Carrying only a narrow network of providers is one way insurers can keep premiums low. But going to a doctor outside the network can mean substantial out-of-pocket costs for consumers.

The marketplace will provide links to the insurers' websites, where shoppers should be able to find lists of network providers, federal officials said.

In addition, consumers should call their doctors to make certain they are part of a plan's network, said Jodi Ray, whose University of South Florida-based program received federal funding to train navigators to help people in most of the state.

Urbanek said he doubts most consumers, especially those who have never purchased coverage, will be able to figure out this complex purchase on their own. "It's hard to imagine," he said. "Our goal is, let's get out there and get them information."

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

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