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Thursday, Nov 27, 2014
Health & Fitness

Health marketplace website logjam stymies brokers

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TAMPA — Bob McKnight has plenty of company as he watches federal health insurance reform get up and running.

The Tampa insurance agent has stacked up 300 potential customers, all wondering whether the online insurance marketplace offers more comprehensive and affordable coverage than what they already have. And like many other licensed brokers and individuals unable to process applications on HealthCare.gov, McKnight has no definitive answers.

He also is fielding calls from a bevy of local residents who already are paying for health coverage for themselves and their families. They’re worried letters they recently received from their insurance companies mean policies they’ve held for years are history.

Add this group to the growing list of people who want health insurance but are growing weary of the logistical logjams, he said.

“The frustration is very real,” he said.

It’s been just a little over three weeks since the federal Health Insurance Marketplace launched its online exchange to about 20 percent of Florida residents, the uninsured and those who buy commercial health plans on their own. Criticism of the website has been loud and clear from Tampa to Washington, D.C., where website contractors testified at a contentious congressional hearing Thursday.

“We’ve been able to enroll people off the exchange,” McKnight said of commercial policies available through insurance companies and brokers. “That process is smooth.”

But local insurance agents say those whose annual incomes are roughly $46,000 a year or less, qualifying them for subsidies and tax credits, are the ones who are being most inconvenienced by the website glitches. They have to wait, as the marketplace or exchange is the only place where income calculations can be determined and applied to help with monthly premiums.

The Affordable Care Act requires most Americans to have health insurance by Jan. 1. However, the federal government will not penalize anyone in the first year who signs up by March 31. (The majority already have coverage via an employer-based plan or via programs such as Medicaid or Medicare.)

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Website problems are only part of the aggravation for the roughly 5 percent of Americans who already purchase their own insurance, said John Peter Barie, a licensed insurance broker and owner of JB Healthcare Solutions of St. Petersburg.

Insurance companies such as Florida Blue, Cigna, Humana, UnitedHealthcare and Aetna are notifying some current customers that their existing policies are missing new “essential” benefits required under the law, such as maternity and newborn care, and mental health and substance abuse services.

Floridians affected by these changes include about 300,000 Florida Blue and 87,000 Cigna customers, 30,000 from HumanaOne, and 8,700 from Aetna.

Individual plans usually don’t offer these benefits, Barie said.

Barie said most of the insurer letters provide options: Keep the existing policy for a one-year grace period but pay a higher premium, or choose a plan that meets the new requirements but will likely cost more.

In general, McKnight said, the added benefits are triggering 20 percent to 50 percent premium increases over his customers’ older, less-comprehensive plans.

Cigna spokesman Joe Mondy said increased premiums aren’t related only to the new benefits being offered. Health care costs continue to rise, regardless of the new law, he said.

“Some premium costs are going up,” Mondy said. “But that’s often the case in renewing any health plan.”

It’s important for consumers who select their own insurance to know that they have plenty of time to research the more than 100 plans available in the Tampa Bay area on the health insurance exchange, McKnight and Barie said.

They advise speaking with a licensed broker, who won’t charge individuals for the expertise but instead earns a commission from insurance companies.

Florida’s Office of Insurance Regulation also has certified 150 trained “navigators” to discuss the exchange with consumers.

Barie said a broker can help assess out-of-pocket costs that need to be considered and can verify whether a favorite doctor, hospital or any important prescription drug is still on the coverage list.

McKnight said people who don’t want those plans can find narrower coverage options in the commercial market, away from the exchange. These “limited” and “short-term” policies will help in case of a disastrous and costly illness.

A consumer may pay smaller monthly premiums for that policy, he said, but also will face a penalty for not having satisfied the 10 essential benefits required by the new health law. The penalty in the first year equals 1 percent of annual income, or $95, whichever is greater.

“It’s better than nothing, but it is not full coverage,” he said.

mshedden@tampatrib.com

(813) 259-7365

Twitter: @MaryShedden

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