It's time to get ready for round two of Obamacare. Open enrollment in PPACA plans runs Nov.15-Feb. 15, and there's plenty that's changed since last year. Hereare some things you need to know.

|

Read: Top 3consumer worries about 2015 enrollment

|

Enrollment numbers, efforts

|

The Obama administration announced that PPACA had 7.3 million paying enrollees as of mid-August,down from the 8 million figure they announced at the end ofenrollment in April.

|

So far, the administration has made no enrollment targets thisyear.

|

Despite the drop in paying enrollees, the administration stillhas made a great dent in the number of uninsured in the country.Gallup numbers put the uninsured rate at 13.4percent, the lowest on record, and largely attributable toPPACA.

|

But the remaining uninsured may be especially hard to reach.According to Kaiser Family Foundation, the remaining uninsuredshave been without coverage for years, and experience many barriersto getting it. Lack of awareness is one. According to a survey fromthe Transamerica Center for Health Studies, forexample, nearly half of those who remain uninsured say they stillhaven't heard of the individual mandate, the law's provisionrequiring them to get health insurance. And 43 percent haven'theard of the exchanges where they may be eligible to purchasehealth insurance.

|

Read: 9 in 10uninsured unaware of PPACA enrollment

|

Thousands more consumers who had their non-PPACA compliant planscancelled may also be shopping for coverage this year.

|

Other challenges exist as the public is less interested inbuying health coverage through the public exchanges during thelaw's second enrollment period, with likelihood of consumers buyingPPACA plans dropping 19 percentage points from last year, accordingto a poll by the Morning Consult.

|

Plus there is a time crunch — the second round of openenrollment lasts only three months, about half the time as lastyear.

|

That's why groups, such as Enroll America — a nonprofit formed in 2011 toget the word out about PPACA — are amping up efforts by hiring morehelp to reach out to those without health coverage.

|

HHS also has thrown hundreds of millions of dollars more atenrollment efforts this year.

|

|

|

Fines

|

Last year, the penalty for not having insurance was $95 or 1percent of household income, whichever was higher.

|

Those fees increase in year two: Those without insurance face afine of $325 per person or 2 percent of income, whichever islarger.

|

Those higher fines might spur more sign-ups, some industryexperts say. But at the same time, cost concerns still plague manywithout coverage. Among consumers still uninsured as of June,nearly 60 percent said they couldn't afford coverage, according toa recent analysis by the Urban Institute.

|

Auto enroll

|

The majority of those who enrolled in PPACA plans through theexchanges will be auto-enrolled in the same health plan theyselected in 2014 this coming enrollment period, as well as receivethe same subsidies, if applicable.

|

The administration announced the law's new auto-enrollment feature back in June as a wayto simplify the enrollment experience for consumers.

|

The new option may also alleviate some of the technicaldifficulties that have plagued HealthCare.gov during the tumultuousfirst year of enrollment, as well as give the administration a headstart on the increasing number of Americans getting coverage underthe law.

|

Consumers who are automatically re-enrolled in PPACA plans willstill have the option of changing plans during open enrollment,according to officials. Enrollees also can return to the system toreport life changes.

|

Even if someone is no longer eligible for a subsidy, they willstill be auto-enrolled in their current plan, just without a taxcredit, HHS says. State-based exchanges may also take thisapproach, HHS says, or may propose an alternative.

|

Industry experts warn that consumers need to review theirprevious plan or else they might face increased costs.

|

Photo: Associated Press

|

|

|

More carriers

|

More carriers are jumping on board to joinPPACA's exchange offerings. Nearly 80 new carriers will participatein PPACA's marketplace this year, increasing the number ofparticipating carriers by 25 percent, federal health officials say.In total, 77 new carriers will offer coverage when open enrollmentfor PPACA begins Nov. 15.

|

The 77 new carriers will be joining those that sell plans in 43states and the District of Columbia where data about insuranceparticipation was available, HHS says.

|

HealthCare.gov will get the bulk of the new carriers: 57carriers will join the federal exchange, bringing to the total upto 248 carriers, a 30 percent increase. Meanwhile, the eightstate-based exchanges where data is already available will have atotal of six more carriers in 2015, a 10 percent net increase overthis year.

|

Read: Carriersexpect PPACA enrollment surge

|

HHS notes that four states out of the 36 on HealthCare.gov —Indiana, Missouri, New Hampshire and West Virginia — will at leastdouble the number of insurers that sold plans there this year. And36 states nationally will get at least one new carrier.

|

Last year, a number of major carriers — including UnitedHealth,the nation's largest carrier — proceeded with caution onto theexchanges during its first year either limiting participation ornot participating at all, for fear the earliest enrollees would besicker.

|

UnitedHealth recently said it will participatein about two dozen exchanges in 2015 after selling in just fivethis year.

|

HHS says their data “demonstrates that the marketplace isworking to increase competition and lower costs for consumers.”

|

Specifically, the agency says, an increase of one carrier in arating area is associated with a 4 percent decline in thesecond-lowest cost silver plan premium, on average. In 2014,consumers in regions with larger numbers of issuers were able toaccess a wider range of choices.

|

Photo: Associated Press/Jim Mone

|

|

|

New management

|

There's no guarantee that HealthCare.gov won't suffer from thesame problems and protest it had last year, but there's now a newface behind the operation.

|

The administration announced in August that Kevin Counihan, former leaderof Connecticut's exchange, will take the reins of HealthCare.gov inhis new role as Marketplace Chief Executive Officer.

|

“We are building strong teams with the focus and know-hownecessary to advance our mission and deliver impact for the peoplewe serve,” HHS Secretary Sylvia Burwell said in late August whenannouncing the position. “We are committed to instilling ongoingaccountability for reaching milestones, measuring results andensuring a successful open enrollment period.”

|

According to an HHS statement, in his new role, “Counihan willbe responsible and accountable for leading the federal Marketplace,managing relationships with state marketplaces, and running theCenter for Consumer Information and Insurance Oversight, whichregulates health insurance at the federal level. He will report toCMS Administrator Marilyn Tavenner.”

|

Counihan has had success in this arena: Connecticut's stateexchange has been one of the most successful in the nation,succeeding enrollment projections. Access Health CT signed up about79,000 people for coverage through Connecticut's exchange, whileanother 120,000 gained Medicaid coverage. Since 2012, the state'suninsured rate has been cut nearly in half, from 7.9 percent to 4percent.

|

Photo: Health and Human Services Secretary Sylvia Burwell.Associated Press/Susan Walsh

|

|

|

Security issues

|

Despite some strides made by the Centers for Medicare &Medicaid Services within the last year, a recent report from theGovernment Accountability Office detailed continued privacy andsecurity weaknesses on HealthCare.gov.

|

“While CMS has taken steps to protect the security and privacyof data processed and maintained by the complex set of systems andinterconnections that support Healthcare.gov, weaknesses remainboth in the processes used for managing information security andprivacy as well as the technical implementation of IT securitycontrols,” the GAO report says.

|

Specifically, GAO says, the CMS has not always “required orenforced strong password controls, adequately restricted access tothe Internet, consistently implemented software patches, andproperly configured an administrative network.”

|

The GAO also detailed six recommendations for HHS to protectprivacy on the federal exchange but it remains to be seen if thoseissues have been resolved.

|

Read: WhyHealthCare.gov launch was ripe for scammers

|

Other unknowns

|

Reports over 2015 premium costs have fluctuated wildly. Recentresearch and approvals, though, has pointed to modest increases inmost major markets driven by increased carrier competition.

|

The question over the legality of PPACA's subsidies — spurred bytwo contradictory court rulings in July — is also creating a bigunknown in PPACA plans. But with numerous appeals expected in thosecourt decisions, the legality of subsidies shouldn't play much intothis year's enrollment — at least not yet.

|

Photo: Associated Press

|

 

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.