Wellington, Colo.-based insurance broker Louise Norris remembers last year's disastrous launch of Obamacare open enrollment all too well. “I don't think we did a single enrollment the whole month of October,” she said.
But since the 2015 open enrollment started Nov. 15, her and her husband's brokerage has been busy signing up people for health coverage from 8 to 6 every day.
Most insurers, hospitals and other enrollment organizations agree that the federal and state exchanges are performing much better this time around. But the process of signing up and re-enrolling millions of Americans still isn't perfect, with some problems reported around the country.
HHS has not released figures on how many people have actually enrolled through HealthCare.gov, but it did say about 100,000 people filed applications the opening weekend. Earlier this month, HHS estimated that a total of 9.1 million to 9.9 million people would enroll in health plans through the state and federal exchanges for 2015. That would be an increase from the 6.7 million Americans who signed up and paid for coverage in 2014.
Several state-run exchanges released their initial enrollment numbers. Massachusetts, where the state-run exchange experienced severe problems during the first open enrollment, said about 20,000 people were deemed eligible for a plan in the first five days. Minnesota, another state with severe exchange dysfunction last time, said its MNSure exchange enrolled more than 1,500 people in plans in the first four days. In California, more than 11,000 people signed up for exchange plans in the first four days, according to a Covered California spokesman. The state hopes to enroll 500,000 new members this year, which would give Covered California about 1.7 million enrollees.
The overall performance of the exchanges so far has been a huge relief for healthcare organizations. “I think all of the work CMS did in terms of testing really paid off,” said Lisa Rubino, a senior vice president at Molina Healthcare, which is offering exchange plans in nine states.
Some new not-for-profit co-op plans, which suffered badly from exchange glitches during the first open enrollment, were especially upbeat. Dr. Ralph Prows, CEO of Oregon's Health CO-OP, said his plan tallied about 500 enrollments on and off-exchange during the opening weekend and has not experienced any problems with the back-end process for receiving enrollment data from the exchange. Oregon switched to using the HealthCare.gov platform this year after a terrible experience with its own technology last time.
Washington state's Healthplanfinder exchange experienced intermittent outages as well as planned maintenance downtime during off hours. These issues arose from the exchange's system for receiving premiums directly from consumers rather than having payments go directly to health plans. Such errors have affected 7,500 Washington customers, most of whom received incorrect invoices. State officials said they hope to rectify those problems by year-end.
In Colorado, which runs its own exchange, insurance broker Norris said it's still somewhat challenging for consumers to qualify for federal premium subsidies. The state exchange has tried to more smoothly integrate the process for determining whether people qualify for Medicaid or a premium tax credit to buy an exchange plan. But she said it's still “not as smooth as it should be.”
Jim Whisler, an actuarial consultant with Deloitte, said he expects there will be cases where previously enrolled consumers who switch plans are double-billed. Many enrollees are shopping for new plans to find a better deal.
Open enrollment has caused confusion for some seniors who are in the midst of the Medicare open enrollment period, which ends Dec. 7. That has required insurers to spend time and effort to educate them that the Obamacare enrollment doesn't apply to them. “They don't always differentiate clearly between Medicare Advantage annual enrollment and open enrollment for the individual marketplace,” said Brigitte Nettesheim, a principal at the Chartis Group consulting firm.
One question mark is whether the Obama administration will extend the open-enrollment window past Feb. 15, similar to its extensions of the 2014 sign-up period. Dan Schuyler, the senior director of exchange technology with Leavitt Partners, said he wouldn't be surprised if HHS issued an extension because many uninsured people are not familiar with shopping for coverage, and lots of Americans will be preoccupied with the holiday season. He said it's going to be a scramble to get people signed up by Dec. 15 so they are covered starting Jan. 1.
But insurers don't like the idea of an extension. “Every time you change deadlines and have to re-message that to the public, you incur confusion and criticism because of that,” Prows said.
Clarfication: An earlier version of this story reported that Oregon's Health CO-OP tallied 500 enrollments during the first open enrollment weekend. The article has been updated to note that the total included enrollment on and off the exchange.
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