Success on the Affordable Care Act website

On Friday, 25 days after enrollment opened on the Affordable Care Act website, a staffer at North Carolina MedAssist helped her first client get far enough to compare health insurance plans and find out about eligibility for a premium subsidy.

"One down and 80,000 to go," said Lori Giang, executive director of MedAssist, a Charlotte-based free pharmacy for low-income people.

That's the estimated number of Mecklenburg County residents who will qualify for premium subsidies in the new health insurance marketplace -- if they can ever get through.

Because of malfunctions, millions of people across the country have been unable to enroll.

Until Friday, trained navigators at MedAssist and other agencies across North Carolina haven't been able to get far enough in the online process to help clients compare insurance plans or determine their eligibility for subsidies.

MedAssist has six staffers and 10 volunteers who have been trained to help consumers buy insurance through the online insurance marketplace. "I want to be able to put them to work," said Susan Royster, MedAssist's associate executive director.

Appointments for a free face-to-face meeting with a navigator are available by calling toll-free 1-855-733-3711.

Friday's successful client, who asked not to be named, is a 60-year-old Mecklenburg resident with a household income of less than $23,000 a year. That is 200 percent of the federal poverty level.

MedAssist navigator Nicole Stanfield helped the client through the process, leading to the news that the client is eligible for a monthly premium subsidy of $552, or $6,624 per year, from the federal government. The client was "overjoyed," Giang said.

The client is able to choose from 28 private insurance plans. The lowest-cost "bronze" plan would have a $12 a month premium after the subsidy. The highest-cost "platinum" plan would have a monthly premium of about $280 after the subsidy.

The client hasn't yet chosen a plan but is reviewing them to make sure the final choice will have the right network of doctors and hospitals and will cover the necessary prescription drugs.

Royster said she shared the news with other agencies in N.C. Community Care Networks, a consortium of organizations that received a federal grant earlier this year to train navigators and application assistants. None had been able to get as far as Stanfield had with Friday's client.

"They were all excited,"  Royster said. "It's only taken 25 days."

No fines if you enroll for health insurance by March 31

A few weeks ago, I wrote that the deadline to sign up for health insurance under the Affordable Care Act -- without getting a fine -- was actually Feb. 15, not March 31 as has been advertised.

But the Obama administration this week announced it will delay imposing penalties for six weeks so that people can safely enroll through March 31. 

The healthcare.gov website has malfunctioned since enrollment opened Oct. 1, but the White House said the delay is not linked with those website problems. Rather, officials said it's a clarification of the law's intent.

The law currently requires that by Jan. 1 most people must have health insurance, and allows enrollment through March 31.  It also allows consumers to be without coverage for less than three consecutive months without a fine.

But to have insurance by March 31, consumers would have to choose a policy by Feb. 15 to allow enough time for their enrollment to be processed so coverage would start March 1. Most insurance coverage begins on the first of the month.

With the new administration announcement, consumers can wait until March 31 to enroll and not face fines.

Here's an article from the Kaiser Health News: 

http://www.kaiserhealthnews.org/Stories/2013/October/23/administration-adjusts-deadline-for-health-law-coverage-penalty.aspx

Charlotte physician named Eisenhower Fellow

Dr. David Callaway, director of the Division of Operational and Disaster Medicine at Carolinas Medical Center, is one of eight U.S. citizens who will be studying abroad next year as USA Eisenhower Fellows.

Dr. David Callaway

The announcement came recently from Retired Gen. Colin L. Powell,  chairman of Eisenhower Fellowships.

Callaway is board-certified in emergency medicine and holds a master's degree focused on national security from Harvard's Kennedy School of Government. During his fellowship, Callaway will examine the impact of the Syrian crisis on the healthcare system and the international security policies of Turkey and Jordan. He will also work with local leaders to identify opportunities for health innovation in crisis zones.

He will travel on an intensive four- to five-week individualized professional program. While abroad, he will meet with experts in business, academia, government and nonprofit institutions working in the areas of health technology, health policy, innovation, national security and public 
policy. 

Eisenhower Fellowships is a private, nonprofit, nonpartisan organization seeking to foster 
international understanding and leadership through the exchange of information, ideas, and 
perspectives among leaders throughout the world. 

Established in 1953 as a birthday tribute to President Dwight D. Eisenhower, the organization has sponsored more than 2,000 Fellows from 108 countries. 

For more information,  www.efworld.org.

Enrollment deadline really Feb. 15 for Affordable Care Act

When enrollment in the Affordable Care Act's new online insurance exchanges opened Oct. 1, those in the know assured everyone there was plenty of time.

Although you have to enroll by Dec. 15 to get insurance starting Jan. 1, the law says the uninsured have until March 31 to be covered and avoid paying a fine.

But it turns out that really isn't true.

The Christian Science Monitor broke the news last week that, because of technicalities in the insurance world, the real deadline if Feb. 15.

Although open enrollment runs through the end of March, individuals are  required to be insured all year in 2014, and the IRS will forgive only brief coverage gaps of less than three consecutive months. (Some people will qualify for exemptions to this rule, such as if they have very low incomes.)

So people need to be covered by insurance in March. And to do that, they'll need to enroll by Feb. 15.

According to the Monitor: "Most companies start their policies on the first of the month, and so to be covered on March 31, one has to buy insurance that starts on March 1. To get insurance that starts on March 1, one has to sign up by around Feb. 15."

I called the Kaiser Family Foundation to find out more. Senior fellow Karen Pollitz said it's worth noting that people who enroll later than Feb. 15 might face only a partial penalty because the penalty is assessed for coverage months.  

Take someone whose income would mean they'd draw a $95 fine for not having insurance next year. If they enroll on Feb 16, coverage will take effect April 1. That means that person will have had a three-month coverage gap. Pollitz said the penalty would be 3/12 x $95, or $23.75.

By the way, the federal government's enrollment website, www.healthcare.gov, still isn't working properly. But a new feature popped up last week that allows consumers to window shop for plans without having to create an account. Without an account, you can't see if you're eligible for a subsidy or how much, but you can get an idea of the number of plans and their before-subsidy costs.

Kaiser's state-specific subsidy calculator  can provide estimates..

Consumer Reports also has launched an interactive tool for consumers.

And here's another from WebMD.

Affordable Care Act website still not working for Charlotteans

Charlotte area consumers ready to search for health insurance on the new federal exchange are still not able to do so.

"We've had to cancel any appointments we've had," said Lori Giang, executive director of North Carolina MedAssist, one of three Charlotte agencies that received money to train "navigators" to help consumers.

The federal exchange, also called the marketplace, is at www.healthcare.gov.

Madison Hardee, a lawyer with Legal Services of the Southern Piedmont, said she is keeping appointments but hasn't been able to enroll clients online. She's helping some of them to fill out paper applications or apply through the North Carolina e-PASS website -- nc.epass.gov -- which is used to enroll clients in other medical assistance programs offered by the state, such as food stamps or Medicaid.

The federal exchange website hasn't been working properly since Oct. 1, the first day of enrollment.
But Hardee said she has heard that some consumers have been able to enroll through the toll-free number, 1-800-318-2596.

"We plan to try that with the next appointment," Hardee said.

For enrollment assistance from navigators and certified application counselors:
--North Carolina MedAssist: 704-536-1790, www.medassist.org.
--Legal Services of the Southern Piedmont: 704-376-1600, www.lssp.org.
--C.W. Williams Community Health Center: 704-405-9510, www.cwwilliams.org.

After Oct. 14, you can make appointments for one-on-one enrollment assistance navigators and application counselors by calling 855-733-3711.

Novant Health will have financial assistants available at two workshops for walk-in visitors: 1-5 p.m. Nov. 6 at the BB&T building, 108 Providence Road in Charlotte, and 3-7 p.m. Nov. 14 at the Salisbury Civic Center, 315 S. Martin Luther King Jr. Ave. S., Salisbury.

Blue Cross and Blue Shield of North Carolina will open two Charlotte stores near the end of October. One will be near Northlake mall, at 9325 Center Lake Drive., and the other in Whitehall Commons, near S. Tryon Street and I-485. It will also have a kiosk at Concord Mills.

New 'lean and mean' co-op health plans threaten the 'bigs'

As enrollment in the Affordable Care Act rolls out this week, it's interesting to see how varied the insurance offerings are in different states.

North Carolina has only two insurance options, Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas. South Carolina has four: BlueCross BlueShield of South Carolina, BlueChoice, Coventry Health Care of the Carolinas and Consumers' Choice Health Plan. That latter is a newly created nonprofit cooperative, which doesn't exist in our state.

In this article for the Center for Public Integrity, Wendell Potter, a former Cigna executive-turned-whistle blower, suggests this is the "beginning of the end of the health insurance industry as we know it." And he refers to co-op plans like the one in South Carolina.

Here's an excerpt:

"One of the things apparent right off the bat is that some of the best deals will be offered by nonprofit health insurers, including the brand new co-op plans that will be available in about half the states. These plans will be lean and mean. They won’t have the enormous overhead costs of the big for-profit insurance corporations that I used to work for, and they won't have to charge extra for coverage just to satisfy the profit demands of shareholders. They won’t have shareholders.

"If you’re wondering why Aetna, Cigna, Humana and UnitedHealth Group, four of the biggest for-profits, are not planning to participate in many of the marketplaces, it’s because they know they cannot be competitive and still satisfy the profit expectations of their shareholders.

"Before long both Wall Street and Main Street will catch on to the idea that the big for-profits are bloated Goliaths that can and will be taken down by the new Davids of the insurance world. The value proposition held out by the bigs for years — that their armies of underwriters, marketers and 'medical management' specialists are essential — will be blown to smithereens.

"The bigs have to know this, and it explains why we are seeing some of their desperation tactics. Like the letter Aetna is sending to some of its policyholders encouraging them to renew early this year so they can avoid the 'big changes' that are on the way."