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Here We Go Again! Getting Ready For Next Round of ACA Sign-ups

Steve Fisher is in the midst of giving his group health clients bad news about rate hikes. He also is spending time cleaning up after bad advice given to individual health care purchasers by over-the-phone navigators and assisters during the most recent enrollment season.

“It’s been crazy here,” he said from his office in Meadville, Pa.

And the second open enrollment season under the Affordable Care Act (ACA) hasn’t even started yet.

Nov. 15 marks the beginning of the next enrollment period. Memories of the glitch-plagued initial enrollment period are still fresh in everyone’s minds as they prepare to get clients re-enrolled in coverage while hoping for a smoother ride this time around. Compounding the anxiety is that this next enrollment period is only three months long – half as much time as was allotted for open enrollment in the initial signup period.

But concerns about how well the website will behave are only a part of the unease surrounding the upcoming enrollment period. The coming year also brings the following:

» In addition to enrolling new participants, those who bought individual coverage last year but want to change their coverage will need to be re-enrolled.

» The online Small Business Health Options Program (SHOP) Marketplace will be open for employers with 50 or fewer full-time-equivalent employees.

» Tax penalties for those who were required to obtain coverage but didn’t do so will go into effect with the federal income tax filing season in early 2015.

Not to mention that some states are seeing additional insurers enter their marketplaces, other states are seeing carriers exit their marketplaces and premium rates are going up almost everywhere.
In the middle of all this – the health insurance advisor.

“We are so far ahead of where we were last year,” said Ed Anderson, financial services manager at Hawkins Insurance Group, Edina, Mo. “We’re still dealing with some issues but at least the system is up and running.” Anderson said he enrolled 150 people in coverage the last time around and “we have continued to get calls ever since enrollment closed.”
How many people who currently have coverage will want or need to re-enroll? That will be a big question to be answered when Nov. 15 hits. Two states whose online systems had problems – Maryland and Massachusetts – are requiring all their enrollees to sign up for coverage again this time. For others, re-enrollment in their current plan will be automatic. But those who wish to change their level of coverage (platinum, gold, silver or bronze), to select a different carrier or to report a change in income level since their previous sign-up will need to go through the process again.

Washington and Lee University law professor and health care expert Timothy Jost estimates that between 6 million and 8 million re-enrollments will take place during the upcoming sign-up season, with a projected 6 million to 7 million new enrollees on top of that. “So that’s up to 15 million people who will be re-enrolling or enrolling over a period of three months rather than the six months that we had last time,” he said. “We will have a more concentrated period of time to get this done than we had before and that could bring challenges.”


Although individuals who don’t want to make changes to their coverage can be automatically re-enrolled, Jost said that it is in most consumers’ best interests to review their coverage and make sure that what they originally signed up for still is the best plan for them.

“People who enrolled in coverage should receive a notice from their insurer before Nov. 15, telling them that they can opt out of their coverage if they wish to make a change,” he said. “And then people also will get a notice from the Centers for Medicare & Medicaid Services saying that ‘this is the information we have on your current household income and the number of people in your household for your tax credit.’ If people don’t respond, they will be given the same tax credit as before. What consumers may not understand is that premiums are age-based and now everyone is a year older than they were when they first signed up, so premiums likely will be going up.”

Jost said that consumers “need to be active shoppers” where health coverage is concerned. He advised them to consult an advisor to find out whether their current plan is really a good deal for them when compared with other plans available.
The best news regarding the new enrollment season, Jost said, is that the federal site and most of the state websites that had problems last time should be corrected in time to handle the surge that will hit come Nov. 15.
The National Association of Health Underwriters (NAHU) has been spending the summer helping get its health advisor members ready to assist people in obtaining coverage.

A major part of the change that the advisor is dealing with in the upcoming sign-up period relates to getting recertified to enroll consumers, said Marcy Buckner, NAHU senior director of state affairs. Advisors who previously had completed Part 1 of their original certification had to repeat it for the new sign-up period. Those who had completed Part 2 of their original certification did not have to repeat the process unless they wanted to be certified to enroll customers in SHOP coverage.

Buckner said interest in enrolling people in coverage remains strong among NAHU members despite challenges encountered the last time around. “Most of the groups we worked with last year to get certified are getting recertified this time,” she said. “In fact, we had 800 members come back and do the Part 1 recertification the first day it was offered.”


The biggest changes in this enrollment period will occur not in the individual market but on the SHOP exchange. SHOP originally had been scheduled to open for small employers on Oct. 1, 2013, but was delayed until the next open enrollment season. The online small business insurance marketplace was delayed for a year while the Obama administration focused its attention on fixing the individual health exchange website. Small businesses had the option to purchase SHOP health insurance plans through an agent, filing a paper application.

The SHOP exchange was meant to give small businesses a way to compare health plans they can offer employees. Beginning in 2014, companies will need to buy through the marketplace to continue receiving a health law tax credit available to employers with fewer than 25 employees.

Buckner said that employers who wish to use an advisor to purchase coverage through SHOP can indicate they wish to do so online, and search for an agent by name or ZIP code.

As the clock ticks toward another enrollment period, advisors are a bit more optimistic for a successful season than they were last year. “We won’t know for sure about what will happen until [the exchange]opens,” Anderson said. “But we know we’re not under the same gun as last year.”

Fisher said his biggest challenges are delivering bad news about rate hikes to his group health clients and dealing with bad advice given by navigators and facilitators.

“My big concern is that navigators, facilitators, people who answer those toll-free numbers are not always explaining the full picture to people who need help with insurance,” he said. “They are not supposed to be giving advice or selling. I’ve had a number of people who have come to me saying that a navigator gave them some advice on their coverage and that advice turned out to be incorrect.”

At NAHU, Buckner said the mood of the members seems to be a bit more positive going into this enrollment period. “We haven’t heard the outcry that we did last year,” she said. “Last year was a huge learning process for everyone.”


Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Follow her on Twitter @INNsusan. Contact her at [email protected].

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