Health Care

Confused about Obamacare enrollment? Burden falls on Florida insurers and advocates

Florida Blue representative Marco Merino (Right) speaks with consumers at Miami Dade College’s Kendall campus on Oct. 25 about open enrollment for Affordable Care Act coverage, which begins on Nov. 1. Many consumers are confused and uncertain about the status of the health law known as Obamacare — leading Florida insurers, enrollment counselors and advocates to gear up outreach efforts.
Florida Blue representative Marco Merino (Right) speaks with consumers at Miami Dade College’s Kendall campus on Oct. 25 about open enrollment for Affordable Care Act coverage, which begins on Nov. 1. Many consumers are confused and uncertain about the status of the health law known as Obamacare — leading Florida insurers, enrollment counselors and advocates to gear up outreach efforts. Miami Herald

Silvy Scherr of Coconut Grove received a letter in the mail last week from her health insurance company, Molina Healthcare, saying that the monthly premium for her Affordable Care Act plan was going to more than triple, from $228 this year to $796 in 2018 for the same coverage.

The window for enrollment and renewal for marketplace coverage was Nov. 1-Dec. 15, but most Florida residents qualify for an extension to Dec. 31 due to Hurricane Irma. Here are tips on how to stay covered.

Scherr, 61, did the math. “It’s substantially over 300 percent,” she said. “I lost sleep. ... Healthcare is so out of reach. It’s unbelievable. You really have to be rich and make a lot of money to be able to afford it.”

What Scherr didn’t know, and neither did Molina, is that the subsidy she receives from the government to lower her monthly premiums will rise, too — enough that Scherr may find coverage in 2018 for even less than she paid this year.

The Affordable Care Act ensures that eligible Florida consumers who earn between $12,000 and $48,000 a year will never pay more than between 2 percent and 9.5 percent of their annual income on monthly health insurance premiums.

With the fifth year of open enrollment for Affordable Care Act coverage due to begin Nov. 1, Florida insurers and consumer advocates have six weeks to reach Scherr and others like her who may be more discouraged and confused than ever about the health law commonly known as Obamacare.

There are challenges including rising premiums, a shorter window to sign up, and confusion over the status of Obamacare.

And that’s drowning out what should be a positive message for most of Florida’s 1.4 million Obamacare consumers — that subsidies will rise to compensate for higher premiums, making better coverage more affordable for many.

That turned out to be true for Scherr. After browsing plans on HealthCare.gov this week, she discovered that her $20,000 annual income as an artist qualified her for a larger monthly subsidy next year. That rise in subsidies is an offshoot of a decision by President Trump to cancel one subsidy, triggering increases in a different subsidy.

The result? Scherr found out that she has several less-costly options.

She can downgrade from her standard plan to basic coverage for no monthly premiums and a $6,650 deductible. She can upgrade to premium coverage for about $60 a month more than she pays now, and a lower deductible. Or she can stay with the same standard plan she had this year, which will cost her the most per month — about $463 — but has the lowest deductible, $700.

“I haven’t made a definite decision,” Scherr said. “But I feel much better.”

Healthcare is so out of reach. It’s unbelievable.

Silvy Scherr of Coconut Grove

As the future of the health law continues to be debated at the White House and in Congress, many ACA exchange consumers are unaware of the key dates for open enrollment, the nonprofit Kaiser Family Foundation’s monthly Health Tracking Poll found in October.

Unlike prior open enrollments for the ACA exchange, the White House isn’t helping as much this year, said Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services, the federal agency that certifies health plans sold on HealthCare.gov.

“There have been messages coming out of HHS [Department of Health and Human Services] that have been more to the frame of ‘Why would you want to enroll in something like this when it's clearly breaking’,” Slavitt said in a conference call with reporters this week.

It’s not just the messaging, Slavitt said. The Trump administration has slashed outreach for open enrollment — reducing the marketing budget by 90 percent to $10 million, and cutting navigator grants for groups that provide in-person counseling by 40 percent to $36 million.

In response, insurers and enrollment groups say they have shifted their outreach efforts into high gear. And they’re finding that consumers are frustrated and uncertain.

Many wonder whether they are even still required to get covered or pay a fine, said Jodi Ray, project director of Florida Covering Kids & Families, a navigator group that received $4.9 million this year from the Trump administration to help enroll Floridians for ACA coverage.

Ray said it’s difficult to communicate a message that many Floridians may see better value on the ACA exchange this year at the same time they are hearing about an average rate increase of 45 percent in Florida for 2018 coverage and President Trump’s executive orders undermining the ACA.

“All of the information that they’re getting right now through media coverage is unfortunately just confusing,” Ray said. “We’ve heard from consumers, they thought the whole thing was repealed already, so they stopped paying their premiums. It’s to that extent.”

The rate of Floridians without health insurance fell nearly 38 percent after the Affordable Care Act exchange debuted in 2014, according to the U.S. Census Bureau. Florida had one of the nation’s highest uninsured rates at 20 percent in 2013. That figure fell to 12.5 percent in 2016, still higher than the national 8.6 percent rate.

The most urgent message that Ray wants to get across to ACA exchange consumers is that they have 45 days to sign up for 2018 coverage, compared to 90 days of open enrollment last year.

The Trump administration also warned that ACA exchange consumers will be automatically enrolled if they fail to sign up by Dec. 15 — and they could be locked into higher-cost plans they don’t want. In the past, consumers who were automatically enrolled received notice encouraging them to check whether they could find better or more affordable coverage.

And the Department of Health and Human Services, the federal agency overseeing enrollment, announced plans to shut down the website healthcare.gov from 12 a.m. to 12 p.m. nearly every Sunday — except Dec. 10 — during the six-week open enrollment period.

However, the Trump administration has said it will staff the consumer call center with 11,000 people for open enrollment, the same number as last year. Starting Nov. 1, consumers can call 800-318-2596 to enroll.

With a smaller grant this year, Ray said her group has hired fewer counselors and spent less on marketing.

“Everything took a hit,” she said. “We have six weeks to help the same amount of people and we have less resources. I don’t know if there is a formula that will give us the ability to do the same or more with less, but we are going to try.”

Florida Covering Kids & Families has stretched its grant dollars, though, by calling consumers before open enrollment begins and signing them up for appointments through the group’s website, CoveringFlorida.org. The Epilepsy Foundation of Florida, another statewide navigator based in Doral, also has scheduled daily events for consumers.

Despite their best efforts, though, Ray worries that counselors will miss many working poor Floridians who move often and have limited resources for staying up-to-date with the health law.

“How many enrollments are you going to get from people who are the most vulnerable, hard to reach and in the highest need,” she said. “They’re not going to get as many because it takes longer to sign them up. It’s complicated, but they need the help the most.”

1.4 million Floridians enrolled in Affordable Care Act coverage in 2017

With fewer navigators and reduced government advertising, insurance companies like Florida Blue are using more advertisements, letters and emails to remind Obamacare consumers to sign up for 2018.

Penny Shaffer, the South Florida market president for Florida Blue, said the insurance company has been hosting “hundreds” of community meetings at its retail centers and in partnership with local groups, such as the YMCA and the Boys and Girls Clubs.

Florida Blue also plans to dispatch teams of counselors to community health fairs, and the insurer has already sent emails and letters to its estimated 1 million members with an ACA plan — the most of any insurer in the state.

Though many Florida consumers with subsidies will find bargains on the ACA exchange for 2018, Shaffer is not convinced that a better value will lead to more sign ups. She said Floridians who want coverage have likely enrolled already or decided they don’t want it.

Shaffer’s more concerned that the debate over Obamacare has caused consumers to tune out and ignore the law’s requirements. She thinks some consumers may be willing to gamble that they won’t have to pay a penalty for failing to enroll, given the Trump administration’s executive order that federal agencies “minimize the economic burden” of Obamacare.

The Internal Revenue Service recently said it will not accept tax returns that do not indicate whether or not a taxpayer met the coverage requirements of Obamacare. But an IRS advisory doesn’t travel as far and wide as the national debate over Obamacare.

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Florida Blue representative Claribel Gonzalez (Left) speaks with Maricely Vazquez Rodriguez (Right) about open enrollment for Affordable Care Act coverage, which begins on Nov. 1. Gonzalez and Rodriguez met at Miami Dade College’s Kendall campus on Oct. 25 as Florida Blue gears up outreach efforts to consumers who are confused and uncertain about the status of the health law known as Obamacare. Omar Antonio Negrin Miami Herald

“You may have a reduction effect from the noise of, ‘Did the thing go away? They voted so many times to repeal it. Has it actually gone away?’,” Shaffer said. “It depends on how educated the consumer is about the current state of things, and it depends on how much somebody may be willing to bet they won’t have to pay the penalty or it won’t be enforced.”

For consumers like Scherr, the Coconut Grove artist, health insurance is a lifeline to her doctor and safety net in case she needs to be hospitalized. Scherr said she has sciatica and chronic back pain, and doesn’t want to gamble with her health.

Each year during open enrollment, Scherr said, she feels the burden of researching plans, coverage options and benefits, and figuring out what she can afford to meet her needs. This year is different because of the many changes.

“I may have overlooked a few things the year before,” she said. “This year, because of Trump, I’m a little bit kind of scared. But it forces me to look harder.”

Daniel Chang: 305-376-2012, @dchangmiami

Affordable Care Act 2018 Open Enrollment

The open enrollment period for 2017 Affordable Care Act coverage runs Nov. 1 through Dec. 15, 2017, for coverage starting on Jan. 1, 2018.

Consumers can visit HealthCare.gov and CuidadodeSalud.gov or call 800-318-2596 to fill out an application and enroll in a 2018 ACA exchange health plan.

Individual consumers who earn $12,000 to $48,000 a year — or $20,000 to $80,000 for a family of three — can qualify for financial aid to help lower their monthly premiums.

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