There are a number of key things that are missing on day one of health care reform. Some are critical for the success of Obamacare. The missing pieces are:
- Only a limited number of insurance company plans have been approved for sale ON or OFF the exchange.
- Lack of consumer awareness about ON exchange and OFF exchange options.
- Lack of awareness about the limited doctor networks offered by some ON exchange insurance companies.
- There are few certified agents available to help consumers in California at this time.
Only A Limited Number Of Health Plans Approved In California
As a broker, I keep a close eye on what the health insurance companies are offering. Most have expressed frustration with California regulators because of how slowly their new Obamacare plans and pricing are being approved.
This will have a big impact as health care reform begins in California. The primary effects are that it will steer more shoppers to the exchanges, and limit the plan choices consumers have. Both of which are not beneficial to Californians.
You could say that this delay in approving OFF exchange health plans might be on purpose. By steering more people to sign up on the Covered CA exchange, the exchange garners additional fees to help fund operations in 2015.
In 2014 the Covered CA exchange is funded in full by the federal government, but in 2015 the exchange must be self funded. The funding mechanism for 2015 is the $14 per person per month Exchange Fee that each insurance company must pay the exchange starting in 2014. The Exchange Fee applies to every person that applies on the Covered CA exchange, but will be spread across all enrollees in California.
ON Exchange And OFF Exchange Options
Most people don’t realize that there are other options outside the Covered CA exchange. However, each of the major insurance companies in California offer their ON exchange plans outside the exchange. The reason is because of the Exchange Fees, and because they offer additional plans also.
Anthem Blue Cross offers 5 additional plans, along with copies of the Covered CA plans, outside the exchange. Cigna, which is not participating inside the exchange, will only offer plans OFF exchange. None of these plans is currently available due to regulatory approval delays by the California Department Of Insurance.
These OFF Exchange plans offer more flexibility to consumers. Although the plans must meet the Bronze, Silver, Gold, and Platinum benefit levels, the actual benefits themselves can be “tweaked”. Different deductibles, copays, coinsurance levels are possible for the OFF exchange plans, and this might result in lower pricing.
Limited Doctor Networks In New Health Care Reform Plans
The benefits of the plans ON the exchange are defined by Covered CA. All plans ON the exchange must provide the defined benefits, so Silver plans are all identical. The only tool insurance companies had available to reduce the cost of Covered CA plans was the provider network.
As a result of this, most carriers have reduced the size of the network they offer on the Covered CA exchange. Each carrier threw out their existing networks, and created a new network by approaching each physician separately rather than by medical groups. This is a slow process and is the main reason why the carriers provider networks are changing every week.
These frequent changes caused the Covered CA exchange to remove their provider network look up tool until the networks stabilized, and the “import” tool at the exchange could be improved.
Checking to ensure your physician accepts your health care reform plan is extremely important. The only option right now is to check the provider network tools at the insurance companies’ websites.
There Are Only Limited Certified Insurance Agents In California
A certified insurance agent is able to help consumers shop and apply for health insurance on the Covered CA exchange. The Navigators and Certified Enrollment Counselors are only able to help people with enrollment questions, not health plan information and recommendations.
On October 1st there were only 7 certified insurance agents in California. At the end of October there are only 2,700 certified out of over 15,000 that applied to be certified. At this rate only half the agents in California will be certified by the end of 2013.
Obamacare enrollment is not a simple process. Most people need help to understand what it’s about, and how to pick the right plan for their needs. Certified Agents have that knowledge and the ability to help people make good choices in a shorter time-frame.
All of these issues make Obamacare enrollment a challenging task. Not many people have been able to get through the Covered CA application process. Enrollment outside of the exchange is currently limited to only Blue Shield and Kaiser Permanente, because they have the only approved applications. If you want to apply with Anthem Blue Cross, Health Net, Cigna, or any other carrier, you must wait until the California Department of Insurance approves the plans, pricing and the applications.
Consequently, many people are in waiting mode. Waiting for more information, waiting for applications, waiting for a broker to help them. The Covered CA goal of getting 2 million Californians enrolled in this initial open enrollment period does not look like it will happen at this pace.