Second open enrollment season brings new challenges

CEDAR RAPIDS - Karen Wielert anticipates that the next few months will be very busy.

But Wielert, an Affordable Care Act navigator for Planned Parenthood of the Heartland, is a social worker by trade and has spent the better part of 20 years helping people find their way through complicated systems.

'I don't always have the right answers,” she said. 'But I can help, and I know how to help consumers get the answers they need.”

Navigators and health insurers selling plans on and off the marketplace are gearing up for some busy and confusing months as open enrollment for health insurance begins Nov. 15 and lasts through Feb. 15.

And although those involved believe the website will run smoother this time around, the second open enrollment period is bringing its own set of challenges.

For one thing, this year's enrollment period is about three months shorter than last year's, which ran from Oct. 1 to March 31.

For last year's period, 29,163 Iowans applied for plans on the market place and another 78,860 enrolled in the Iowa Health and Wellness Plan, the state's response to expanding Medicaid.

'We're still not in a place of the new normal yet,” said Dana Woods McNeill, vice president of corporate communications and stakeholder engagement for CoOportunity Health, a Des Moines-based not-for-profit health insurer. 'There are a lot of things that will be challenging.”

Traci McBee, a Wellmark Blue Cross Blue Shield of Iowa spokeswoman, echoed those sentiments.

'We know this can be a confusing time,” she said. 'We want Iowans to know that they don't have to do this alone.”

The Marketplace

A total of 77 new insurers nationwide will offer Marketplace coverage - a 25 percent increase from last year, according to the U.S. Department of Health and Human Services.

Here in Iowa, the Marketplace will look similar to as it did last year. Wellmark announced in June that it again would put off participation on the public exchange in 2015 - waiting until 2016 to join.

'Every company determines where to sell their products, and we made this decision considering a number of variables,” said Laura Jackson, Wellmark executive vice president of health care innovation and business development, in a statement back in June. 'We looked at factors like the probability of a state- or regional-based exchange and the continued challenges with the current public exchange, to name a few.”

CoOportunity Health and Coventry Health Care of Iowa again will sell products on the Marketplace, though with some changes in policy options.

Last year, more than 63,000 people in Iowa and Nebraska enrolled in a CoOportunity Health insurance plan. Woods McNeil said the insurer isn't making any projections for this enrollment period.

Consumers also can buy plans outside the Marketplace that still meet the Affordable Care Act's coverage requirements. However, they won't be eligible for federal tax subsidies.

'The public exchange is only one potential distribution channel for consumers to purchase health insurance,” McBee said.

Extending plans

Despite not being on the public exchange in 2014, Wellmark sold more than 24,000 ACA-compliant plans that represented more than 41,000 policyholders in Iowa and South Dakota.

In April, Wellmark offered an extension to its policy holders with non-ACA-compliant plans, allowing them to keep their plans until October 2016.

'Preserving the option to extend plans again this year means that our members can continue to keep the health insurance plans they want, know and trust while still having the flexibility to move to new ACA plans if those would better meet their needs,” McBee said.

McBee said more than 90 percent of Wellmark individual policyholders and approximately 85 percent of small business groups chose to keep and extend their plans when it gave members the option to extend their policies in 2013.

The company also is offering a new plan this year - the Blue Rewards plan, integrates the UnityPoint Health provider network combined with Hy-Vee's pharmacy, healthy food, wellness and dietitian services along with Wellmark Blue Cross and Blue Shield's ACA-health insurance option.

Enrollments and Re-enrollments

This year's open enrollment period has one big difference compared with last year - renewals, the people who signed up for insurance last year and need to reapply for their benefits.

'Our sole focus last year was enrolling those without insurance,” Woods McNeil said. 'Renewals are critically important.”

Consumers should begin receiving letters from the Centers for Medicare and Medicaid Services during the first two weeks of November, informing them of the open enrollment period and what they will have to update. Those who have changed jobs or are making a different salary than last year also may have to reapply for tax subsidies.

In the meantime, CoOportunity Health is training brokers and agents to better understand the process, sending out a newsletter to members with renewal information and setting up a hotline for consumers who have questions.

Wielert and three other navigators are working on outreach and educational programs to help individuals and small businesses. They answer questions, advocate, help with enrollment activities and help users 'navigate the system,” Wielert said.

The navigators also work with different organizations to identify the best avenues to reach the target population - the uninsured.

And with the tax penalty increasing this year, Wielert said that 'the financial incentive to get insurance is becoming greater.”

Open Enrollment Timeline

' Nov. 15 - Open Enrollment starts

' Dec. 15 - The last date to enroll for coverage that starts Jan. 1, 2015

' Dec. 31 - Date when all 2014 Marketplace coverage ends

' Jan. 1 - The date 2015 coverage can start if you apply by Dec. 15, 2014, or if you accept automatic enrollment in your 2014 plan

' Feb. 15 - The last day to enroll in 2015 coverage. Those who miss this deadline can't sign up for a health plan for the rest of 2015, unless they qualify for a Special Enrollment Period.

Source: Healthcare.gov

Special Enrollment period

A Special Enrollment period is the 60 days after consumers experience a major life event that allows them to sign up for health insurance outside of the Open Enrollment period. Consumers are eligible for Special Enrollment if the following events occur:

' Marriage

' Divorce

' Birth or adoption of a child

' Loss of health coverage due to loss of a job.

Source: Healthcare.gov