Amid health-care woes, would-be buyers do what they can

Moises Candray, 30, creates an account at Healthcare.gov with help from Samantha Rivera during a health fair Friday, Oct. 25, at Congreso, the Latino human services organization in North Philadelphia. Candray is hoping to buy insurance through the exchange for himself; his wife and kids are covered through her employers's policy, which he said would cost $500 more a month with him on it. Although he created an account at Congreso, the web site would not let him go any further to determine what subsidy he might qualify for or to see his plan choices. Candray, a restaurant manager whose employer does not offer insurance, has gone back online from home several times since - at night and during the day, on a computer and a smartphone - but has not gotten any further. ( Don Sapatkin / staff )
Moises Candray, 30, creates an account at Healthcare.gov with help from Samantha Rivera during a health fair Friday, Oct. 25, at Congreso, the Latino human services organization in North Philadelphia. Candray is hoping to buy insurance through the exchange for himself; his wife and kids are covered through her employers's policy, which he said would cost $500 more a month with him on it. Although he created an account at Congreso, the web site would not let him go any further to determine what subsidy he might qualify for or to see his plan choices. Candray, a restaurant manager whose employer does not offer insurance, has gone back online from home several times since - at night and during the day, on a computer and a smartphone - but has not gotten any further. ( Don Sapatkin / staff )
Posted: October 31, 2013

With the federal website still on the fritz after four weeks, people here seeking the affordable insurance promised by Obamacare are doing what they can on their own. Some are finding policies on insurers' websites, or estimating subsidies using independent calculators. Others are going as far as they can in the sign-up process at Healthcare.gov, hoping they can return to finish choosing coverage later.

Groups that work with low-income people say that most are taking it in stride. But there are exceptions. Some people are finding that the insurance plans that they had - and may have been happy with - will be canceled Dec. 31 because the plans don't meet the stricter requirements of the Affordable Care Act.

And in Pennsylvania, individuals who earn below $11,500 or families of four below $23,500 are discovering they aren't eligible for any assistance at all because the state has not yet expanded Medicaid.

Sign-ups were moving more quickly in New Jersey, advocacy groups said, because roughly half of those seeking coverage are qualifying for the expansion there. They said that the state's website for Medicaid, www.njfamilycare.org, was working well.

The federal website was designed mainly for people with somewhat higher incomes - up to $46,000 for an individual and $94,000 for a family of four - to purchase subsidized commercial policies through the exchange. Some advocacy groups maintained that problems with the federal site may actually be helping to simplify the complex process because they were forcing consumers to spend more time elsewhere examining plan details that won't be on the federal site.

They can go to insurance company sites, for example - two companies are offering exchange policies in Southeastern Pennsylvania, and three in New Jersey - and scrutinize the policies.

Some plans have tiers of hospitals and doctors, which could dramatically affect how much you pay out of pocket, said Ray Castro, senior policy analyst for New Jersey Policy Perspective, a research organization. "You should look at things like how many specialists are in one plan vs. another plan, how many hospitals are in a plan, and, if you have health problems like diabetes, in your whole network how many providers are there" that specialize in diabetes?

Groups that got grants to help people enroll said they were relying more than expected on the 24-hour phone line at 1-800-318-2596 and paper applications.

"It just takes a lot longer to do a paper application because you have to go back and forth in the mail," first to determine eligibility for subsidies and then to start selecting plans, said Antoinette Kraus, director of the Pennsylvania Health Access Network. "We have been giving folks the paper application to get familiar with it, and then to go online."

One surprise has been interest in insurance from "young seniors," people no longer working but not yet eligible for Medicare and who may be paying high rates on the individual market or for COBRA, said Suzanne Cohen, a spokeswoman for the Health Federation of Philadelphia, which is helping people at city-operated health centers.

Another has been people nationwide who have insurance policies on the individual market and received cancellation letters effective Dec. 31 (or, in some cases, the 2014 renewal date) because their plans do not meet minimum qualifications of the federal law.

Independence Blue Cross sent letters to about 24,000 policyholders, representing fewer than 2 percent of its total members but 45 percent of its individual policies. Horizon Blue Cross Blue Shield of New Jersey sent 90,000 letters to individual subscribers, representing 70 percent of that market.

Although the broader coverage now required by law - maternity benefits, for example - may raise the base price, many subscribers will now be eligible for subsidies, making it impossible to accurately compare costs.

Perhaps the biggest surprise is people who discover they fall into what is being called the Medicaid expansion "gap" - those who make less than the minimum for subsidies on the exchange but live in states that have not yet agreed to expand Medicaid, which the federal law envisioned would cover the lowest-income people but was made optional by the U.S. Supreme Court.

"I think they have heard that all Americans can get health insurance and they are upset to hear that they make too little money," said Kate Kozeniewski, who trains the navigators who help sign-ups at Resources for Human Development, a social service group.

Sitting at a computer terminal Friday at Congreso, an organization that serves the Latino community in North Philadelphia, Moises Candray worked his way through a series of screens at Healthcare.gov, entering a ream of financial and personal information before the site would go no further.

Candray, 30, manages a restaurant kitchen but receives no insurance from his employer; his wife and children are covered under her work policy but adding him would cost an additional $500 a month, he said. So he is hoping for Obamacare.

Despite repeated attempts to continue his online application at home, he does not know what subsidies he may be eligible for. Still, his low income and large family - under $20,000, with a household of six - may mean no premium assistance will be available. That could change if Pennsylvania expands Medicaid, as Gov. Corbett has proposed to do using an alternative plan, but approval is not likely for months.

Despite the website's woes, he and anyone else are free to buy exchange insurance policies directly from the insurer, although premiums would be unsubsidized. Since most people are expected to qualify for subsidies, that number is likely to be small; the Obama administration estimated Monday that two-thirds of young adults could buy insurance with premiums of $100 a month or less after tax credits.

Insurance companies have declined to say how many policies have been sold, deferring to the administration to announce the numbers.

Traffic on Independence Blue Cross' website has doubled since Oct. 1 and call volume has tripled, said Brian Lobley, senior vice president for marketing and consumer business. More than 6,000 people have visited the Independence Express, the insurer's outreach tractor-trailer, at 148 sites; three more are scheduled Wednesday, including 5 p.m. at the 76ers game at the Wells Fargo Center.

Interest has "exceeded my expectations," said Lobley, who said a lot of the activity was "kind of like window-shopping" plans, with help from representatives. People can make an appointment to come back to finish the process later.

"We are in a kind of rain-check environment," he said.


Details on Insurer Websites

Although problems continue at www.Healthcare.gov, the federal website set up to determine eligibility for subsidies and accept applications, you can go to insurance company sites now.

Those sites contain plan details such as copays, deductibles, and provider networks, which may turn out to be just as important as premium subsidies.

Southeastern Pennsylvania

Independence Blue Cross:www.ibx4you.com

Aetna:https://healthinsurance.aetna.com

New Jersey

Horizon Blue Cross Blue Shield of New Jersey: https://secure.horizonblue.com/consumer/web/public/need-insurance/horizon/need-insurance/browse-plans/individual-and-family-plans

AmeriHealth New Jersey:www.amerihealth.com/htdocs/custom/nj/ffm_subsidy.html

Health Republic Insurance of New Jersey:https://newjersey.healthrepublic.us/individual/


dsapatkin@phillynews.com

215-854-2617 @DonSapatkin

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