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Lessons Learned From the First Open Enrollment

Texas experienced the first open enrollment period from October 15, 2013 to March 31, 2014 to sign up for health insurance coverage under the Affordable Care Act (ACA).

Both Texas consumers and the health insurance industry learned a great deal, which will be helpful as the next open enrollment period from November 15, 2014 to February 15, 2015 is implemented.

Enrollment System Did Work

Although the Federally-Facilitated Market (FFM) launched with a catastrophic beginning, by January the systems were operational and functioned quite well as enrollment neared completion. What impacted functionality after the initial rollout was enrollment volume. During mid-month periods, which were the deadlines for first of the following month effective dates, the increase in volume would overwhelm the FFM website, resulting in delays or incomplete enrollment.

The problems were most evident during the last days of the open enrollment period when volume increased substantially and the system shutdown completely. Outside of these periods of extremely high volume, the enrollment process worked adequately, subsidy determinations were made accurately and enrollment was completed in a timely manner.

Lesson Learned: Delaying enrollment increased the chance of problems, and those individuals who enrolled early each month had a much better customer experience because they avoided the enrollment bottleneck.

Premium Subsidies Made Coverage Very Attractive

Those Texas consumers who qualified for an advanced tax credit or subsidy to reduce their monthly premium cost were recipients of welcome premium relief. Depending on the size of the family and expected 2014 income, health insurance applicants realized premium reductions in the form of a federal subsidy. Individual incomes above $11,490 and family incomes above a range of $15,510 and $39,630 were the beneficiaries of financial support, which reduced their premium cost and made health insurance more affordable.

Those individuals and families who based on their income qualified for cost sharing to reduce their out-of-pocket costs benefited from reductions in their deductible and coinsurance, which decreased their deductible to as low as zero and their out-of-pocket maximum to as low as $500.
Lesson Learned: Always determine if you qualify for a subsidy. Even if the income is on the high side of the scale, any reduction in premium should be taken.

Guaranteed Issue and No Preexisting Conditions Were a Huge Benefit

For the first time in the individual market, health insurance coverage was available guaranteed.

There were no health questions, which made the application process much smoother, and there were no waiting times for preexisting conditions. Texans could apply for coverage and know that any pending treatments would be covered according to the effective date of coverage.

Guaranteed issue and no waiting period for preexisting conditions meant that Texas consumers could select a plan according to the best coverage for an upcoming treatment.

Lesson Learned: Coverage could be tailored to provide the benefits necessary to deal with a known medical condition.

Premiums Were Higher Than Consumers Expected

The universal comment Stateside personnel heard during open enrollment was, "I thought this was supposed to be the affordable care act." Texas consumers, even with the subsidy, were taken back with the cost of coverage. The principal drivers in the higher premium cost were guaranteed issue and the mandated benefits.

Guaranteed issue meant that health insurance carriers had to take all applicants regardless of health history or current medical condition. No longer could health insurance carriers manage cost by excluding applicants that were considered too risky.

The ACA's risk adjustment, reinsurance, and risk corridors programs are intended to protect against the negative effects of adverse selection and risk selection, and work to stabilize premiums, particularly during the initial years of ACA implementation.
The mandated benefits probably had the most significant impact on premium cost because Texas consumers previously could select plans with more limited benefits in order to reduce premium cost. With adoption of the ACA, all health insurance coverage must meet essential benefit requirements as established by the federal government. Texas plans now include maternity benefits, adult preventative care benefits, substance use benefits and broad prescription benefits, which all contribute to higher premium cost.
Lesson Learned: Higher premium cost, even with a subsidy, was the largest deterrent to enrollment in an ACA compliant health plan.
Carrier Customer Service Suffered
Although health insurance carriers had over three years to prepare for open enrollment, they were not ready for the large number of applicants and the increased complexity of the enrollment process created by the subsidy determination. Stateside heard from many Texas consumers that wait times to speak with a carrier representative was 3 to 4 hours. Premium payments were not posted in a timely manner causing issues when a provider tried to confirm coverage status during a policyholder's visit. Enrollment material was either late in being distributed to policyholders or was not distributed at all. Carrier customer service representatives were not properly trained and failed to give accurate information. All of these issues and many more created a less than satisfactory customer service experience.

Lesson Learned: Those consumers who utilized the services of a broker as compared to working directly with a carrier received much better customer service in terms of response, accuracy and quality.

Lack of Consumer Awareness

Even with the ACA being headline news for over three years and a wealth of information being provided by the federal government, health insurance industry and brokers, Texas consumers were still largely in the dark regarding details of the ACA. Important aspects of the law regarding the enrollment period, premium cost, subsidy determination, network limitations, and benefits were largely ignored by Texas consumers. The lack of information regarding the requirement to secure coverage by March 31, 2014 or not be insured was the reason enrollment volume was so high at the conclusion. Many Texas consumers did not want to enroll believing that they had to go through the Marketplace website, even though no subsidy was being applied. Applicants did not understand the implications of an HMO plan and the network restrictions.
2015 Open Enrollment
Leading up to the 2015 open enrollment period Stateside Insurance Services is available for questions. Stateside will begin reaching out to clients in late September in preparation for open enrollment. The next open enrollment will be especially critical because the open enrollment window has shrunk from 6 months (October 1, 2014 to March 31, 2014) to 3 months (November 15, 2014 to February 15, 2015. It will also be unlikely that the next open enrollment period will offer any type of application extension because the enrollment systems should be completely functioning by then. Do not hesitate to contact Stateside by email at or by telephone at (866) 444-3332 (toll free).

Contact Stateside to Discuss ACA Updates

The sooner you provide your information, the easier Open Enrollment will be for you! Stateside Insurance Services has helped Texans understand the complexities of health insurance since 2003. Feel free to contact our Stateside Team by email at or call us at (866) 444.3332 to discuss your coverage situation and to determine how healthcare reform will affect your coverage options.
You can contact Stateside Insurance Services in whichever way is most convenient for you:
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