Managers of the Affordable Care Act public health insurance program in Nevada are facing the same kind of confusion about the 2018 market that's plaguing ordinary insurance agents and brokers.

Heather Korbulic, the executive director of Nevada's Silver State Health Insurance program, talks about the confusion in a monthly update she prepared for an upcoming program board meeting.

Korbulic says she and colleagues at other state-based ACA exchange programs have been asking the Centers for Medicare and Medicaid Services questions about how the 2018 individual major medical open enrollment period might work.

"I have yet to receive any answers to my questions, or indication as to when we will receive answers," Korbulic writes in the update.

HealthCare.gov basics

Nevada started out trying to offer a state-based, state-operated ACA public exchange program.

The state had trouble getting its exchange enrollment and account administration services to work smoothly, and it's now leasing use of systems operated by HealthCare.gov to power its exchange, which does business as the Nevada Health Link exchange.

The drafters of the ACA created the exchange system to give consumers a standardized, web-based way to shop for health coverage, and to administer the ACA premium tax credit and cost-sharing reduction subsidy programs.

The U.S. Department of Health and Human Services established HealthCare.gov to provide ACA exchange services in states that are unwilling or unable to handle the jobs themselves.

'Open enrollment period' system

The ACA prohibits insurers from considering individual health conditions when deciding whether to sell people coverage, or from considering individual health factors other than age, location and tobacco use when setting prices for coverage.

Insurers, insurance regulators and exchange program managers developed an "open enrollment period" system, or limits on when consumers have an easy time buying coverage without having what insurers classify as a good reason to be shopping for coverage, to push younger, healthier people to pay for coverage even when they feel good.

The idea is that people will buy coverage during the open enrollment period, to avoid getting stuck without any practical way to buy health coverage, or pay for health care, at other times of the year.

Insurers fear that, without the open enrollment period system, consumers would see the ACA restrictions on medical underwriting as an invitation to wait until they get sick to pay for coverage.

2018 open enrollment period

The ACA public exchange system came to life in 2014. For the past few years, the open enrollment period has run from Nov. 1 through Jan. 31 in most of the country.

This year, HealthCare.gov managers plan to shorten the open enrollment period for 2018. The open enrollment period is now set to run from Nov. 1 through Dec. 15.

Korbulic writes in the update that she and her colleagues want to know what kind of infrastructure HealthCare.gov managers have to support the shortened open enrollment period.

State exchange program managers also want to know how HealthCare.gov will reach out to consumers.

The lack of answers "is particularly frustrating, considering the [Nevada] exchange is set to spend over $5 million to lease HealthCare.gov for 2017," Korbulic writes.

Nevada will offer its own state-funded marketing program regardless of what HealthCare.gov, Korbulic says.

The Nevada exchange program recently lost plans from Aetna Inc. and Anthem Inc., but it's still on track to offer plans from Centene Corp. and Health Plan of Nevada, Korbulic says.

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