The opening hours of the Affordable Care Act's third open-enrollment period passed with no major technological glitches, putting the meltdown during the first enrollment in fall 2013 farther into the Obama administration's rearview mirror.
State-based insurance exchanges and the federal HealthCare.gov site opened Sunday morning. Federal officials said 40,000 health plan applications were submitted in the first six hours through HealthCare.gov. Call volumes were relatively modest, with officials stressing the Sunday launch would lead to lower initial surges compared with last year's kickoff.
Indeed, the actual number of people signing up appears to be slow in the early stages. The challenge for federal and state government officials now turns to educating the public about their health insurance options over the next three months and about the tax penalties they could face if they don't buy coverage soon. Enrollment efforts are also in full swing for Medicare and employers.
Jessica McCarron, a spokesperson for Enroll America, a not-for-profit group that helps people sign up for coverage, said the first day was "slow but steady." The group saw a mix of people who were enrolling for the first time as well as repeat customers, she said. On Monday, state and federal officials were reporting higher volumes.
Enroll America is directing much of its manpower and resources toward in-person assistance. Aside from hosting local community events, the group has scheduled 2,000 appointments for prospective shoppers to meet with people who will walk them through the enrollment process, McCarron said.
States that established their own marketplaces similarly reported no major obstacles. In Idaho, the state exchange website had more than 60,000 views the first day.
“We feel like things are going quite well,” said Pat Kelly, executive director of Your Health Idaho, the state-based insurance exchange. “The system has been performing as expected. We're cautiously optimistic.”
Kelly said most consumer queries involved the rate increases, premium subsidies and comparison shopping. The exchange has stressed that even though rates are going up for some plan options, the tax credits will offset much of the increase. Idaho had almost 86,000 paying members as of June 30, and Kelly said the state is expecting anywhere from 90,000 to 93,000 members to re-enroll or sign up this year.
Minnesota's state-based exchange has reported no issues thus far, and call center wait times have averaged about four seconds, said Shane Delaney, a spokesperson for MNsure. Officials in California and Massachusetts also said their respective exchanges were performing well overall, although Massachusetts was experiencing some problems with its electronic signature page.
HHS expects 10 million people will have health coverage through the exchanges by the end of 2016, a modest increase from the 9.1 million expected to still have coverage by the end of this year. Premiums are going up for many health plans next year, and retaining a large portion of the current base will require people to return to the marketplace and find the best value for them or their families.
“The key message is that people should shop,” said Larry Levitt, a senior vice president and health insurance expert at the Kaiser Family Foundation. About 31% of people with a 2014 plan shopped and switched to a new plan for 2015, according to HHS data.
“There's still quite a bit of volatility in the market with plans jockeying for competitive position,” Levitt said. “And many people could find themselves with substantial premium increases if they are not willing to switch plans.”
While state and federal officials have been vocal about the monthly prices and potential penalties if coverage isn't purchased, less has been said about the total cost of health plans and cost-sharing reductions. Many coverage options have high deductibles and variable out-of-pocket obligations. The ACA offers cost-sharing subsidies for people who earn less than 250% of the federal poverty level, but they must buy a silver-level plan. Those subsidies have earned little real estate in state and federal outreach materials.
However, HealthCare.gov does offer more detailed information this year about out-of-pocket costs and an estimator of how much medical care the enrollee or family expects to use next year.
The ACA's open enrollment has dominated headlines, but the more populous Medicare and employer enrollment periods are also underway.
Medicare's annual enrollment began Oct. 15. Over the past few years, private insurers that offer Medicare Advantage and prescription drugs plans have recorded more sign-ups. Almost 18 million people have a Medicare Advantage plan as of October, or about a third of all Medicare beneficiaries. The CMS will release its latest Medicare figures in a couple of weeks, giving a snapshot of how many more seniors are moving toward Advantage.
Employer open enrollments generally are less meaningful because most workers re-enroll in the plans they have. A 2013 study showed only about 1 in 8 nonelderly Americans with employer health coverage switched health plans in 2010. But some employers are trying to change that passivity through private exchanges that encourage more active plan selection.
