During Obamacare's first open-enrollment period, Geisinger Health Plan was inundated with queries as consumers struggled to figure out what health insurance meant for them.
Phone volumes were six times higher than they were historically. The provider-owned plan, part of Geisinger Health System, Danville, Pa., created a website on healthcare reform. That's when Web hits “went through the roof,” said Joseph Haddock, Geisinger Health Plan's chief sales officer. “The volumes were extremely significant relative to what we experienced in the past.”
Geisinger is expecting more of the same when open enrollment for 2015 coverage on the insurance exchanges starts Nov. 15. “Looking ahead, we would expect a high volume again,” he said.
Geisinger, which has about 470,000 enrollees, signed up more than 25,000 people in exchange plans last year. Haddock expects to add up to half of that amount this year. That has prompted the not-for-profit health plan to bump up staffing in its sales call center by 20%. And Geisinger is not alone.
Despite Republican promises to repeal the Patient Protection and Affordable Care Act, a number of smaller and larger health insurers say they are adding personnel to handle the three-month open-enrollment period established by the law, and are bullish on signups for 2015 coverage. Insurers say the increased staffing comes in response to last year's busy enrollment period, in which 7.3 million Americans bought individual-market plans on the state and federal exchanges and about 7.8 million purchased plans off the exchanges. They are prepared for a big surge in late January and February, close to the cutoff deadline, which is what happened during the first open enrollment. The Congressional Budget Office has estimated that a total of 13 million people will be enrolled in exchange plan coverage in 2015.
Insurers are expecting that uninsured people who did not buy coverage the first time around may be convinced to get it this time because of bigger tax penalties for remaining uninsured in 2015. Under the ACA's individual mandate, most Americans who don't have health coverage for 2015 will have to pay the higher of $325 or 2% of income, compared with the 2014 penalties of $95 or 1% of income.
EmblemHealth, a $10 billion New York health insurer that covers about 4 million people, is boosting customer-service staffing by 30% to 40% compared with last year. The company brought on a team solely dedicated to processing e-mails. It also expanded operating hours and is now open on Sundays. Suzanne Ronner, vice president of customer service, said training, recruiting and hiring of new employees started a month earlier this year.
With one year of new data under its belt, EmblemHealth is using workforce management software to highlight the peaks and valleys of consumer engagement. The insurer, a major player on New York's exchange that enrolled 43,000 exchange members last year, has forecasting levels down to half-hour intervals.
“Everybody thinks it's just about picking up a phone and being polite and doing the right thing,” Ronner said. “But it's also a very analytical business.”
Eric Schultz, CEO of $2.6 billion Harvard Pilgrim Health Care, which offers plans throughout New England, said he expects “substantial” growth in the individual insurance market and similarly will add personnel where needed. Many of the new consumer-governed co-op plans created with ACA-provided loans also are analyzing staffing needs in case volumes are as robust as last year.
HealthyCT, Connecticut's co-op plan, garnered 3% of the state's exchange market last year. With a goal of increasing that figure to 10%, the not-for-profit insurer boosted its employee base from 40 to 50. Colorado HealthOP signed up 14,000 people last year and hopes to double enrollment this year, CEO Julia Hutchins said. The insurer has made contingency plans with a temporary staffing firm to bring on people to field phone calls.
“It's difficult to anticipate how big the surge will be, but it tends to come near the end of the deadline,” Hutchins said. She noted that Dec. 15 will be a particularly important date, since that is the last day a consumer can buy insurance and have it go into effect starting Jan. 1.
Most people who bought health plans last year did so on the Internet or on the phone, according to new Kaiser Family Foundation data. But more than one in four people also spent time with someone in person to learn about or sign up for insurance. That's led to many insurers to open their own retail stores. Blue Cross and Blue Shield plans have pursued this strategy the most. Geisinger Health Plan will open its first retail store Nov. 15, Haddock said.
Insurers say ramping up staffing is essential for educating consumers about their options. Such education is necessary because uninsured Americans often know little about health insurance or about signing up for coverage under the healthcare reform law. A Kaiser Family Foundation poll found 90% had no idea the annual enrollment period begins Nov. 15. Haddock said there still are many consumers in his service area who know nothing about the law's premium or cost-sharing subsidies—or even that the exchanges exist and they potentially face tax penalties for not buying coverage.
Insurers that reach consumers early and often during the upcoming enrollment period ultimately could win bigger chunks of the market, including more younger and healthier people to balance the costs of enrolling people with pre-existing health conditions. But that requires investment.
“We realize that this is a new area for many people who have never had health coverage before,” EmblemHealth's Ronner said. “It's big, it's different, it's new. What we realized is people still really need education.”
Even with more hands on deck, the industry expects some hiccups in the exchange enrollment process. Geisinger's Haddock said the CMS has made several process improvements in the HealthCare.gov website, such as shortening the online application to three pages for individual consumers. But he still anticipates Geisinger employees will have to follow up with new applicants who don't pay the first month's premium—the final step in the enrollment process—and that there likely will be continued lags in the CMS' processing of premium tax credits paid to insurers.
Those logistical challenges don't seem to be reducing insurers' appetite to reach the burgeoning individual market—and insurers don't expect consumers to be put off either. “The consumers that came onboard last year have found value in having insurance,” said Ken Lalime, CEO of HealthyCT. “There's a swell of consumerism that will bring people to the exchange and brokers.”
Follow Bob Herman on Twitter: @MHbherman