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Topics: Obamacare

Here's how paying for an Obamacare plan is supposed to work

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Beltway Confidential,Philip Klein,Obamacare,Health and Human Services

On Nov. 13, when the Department of Health and Human Services announced that 106,185 Americans had signed up in plans through President Obama’s health care program, officials used a novel definition of “enrollment.”

Though insurers traditionally haven't counted individuals as enrolled until they've paid their first month's premiums, the HHS report declared, "Enrollment figures include those who have selected a plan and have or have not yet paid the first month's premium."

HHS did not provide a number for those who have paid.

On Tuesday, Henry Chao, the deputy chief information officer at the Centers for Medicare and Medicaid Services, raised eyebrows when he testified before the House Energy and Commerce Committee that the payment system for the federal health insurance exchange hadn't yet been built.

Taken together, these revelations have led to a lot of confusion about the payment system for the federal health exchange. They’ve also prompted rather basic questions, such as: Have people successfully paid for health insurance through Obamacare? And if so, how does paying for insurance work?

The answer to the first question is: yes, but not many. The answer to the second question is: It’s complicated.

If the system were fully functional, individuals would visit the federal healthcare.gov insurance exchange website, set up an account, fill out information to determine their eligibility for subsidies and eventually pick a plan.

The federal government does not receive payments from consumers. But the government will eventually transfer to insurers federal subsidy money to assist qualifying Americans with monthly premiums.

Once individuals have chosen a plan, according to an HHS official who responded by email, if they click on a payment button, they would be referred to the website of the insurance company that issued their chosen plan. Then, they would follow instructions from the insurer about how to pay their portion of the premium.

Like much of the technology surrounding the rollout of Obamacare, this process is not currently functioning smoothly.

Behind the scenes, when an individual selects a plan, the federal system transmits a file, known as an “834," with all of the relevant information about that individual and his or her plan selection.

These files have been plagued by errors, from spouses and children being mixed up to enrollments being duplicated or inadvertently cancelled. According to HHS, they have “completed fixes for two-thirds of the high-priority bugs that our tech team working with issuers identified as being responsible for the issues with 834 transactions and other issuer priorities.”

But according to an insurance industry source, though the 834 problems are getting better, there is still a long way to go. Insurers still haven’t reached the point where they can feel confident that the data is reliable.

As a result, though they have been able to process some payments from individuals, they’ve only been able to do so on piecemeal basis in cases where they are fully confident in the data, often because it’s been verified by hand.

Under changes announced Friday, individuals now have until Dec. 23 to pick a plan if they want coverage to kick in as of Jan. 1. They would have until Dec. 31 to pay the first month’s premiums.

As originally conceived, on at least a monthly basis, the government and the insurers were supposed to go through a process of “reconciliation” to make sure that the 834 forms the government has on file match up with the ones insurers have on file. That process has not yet taken place.

At some point about the middle of January, the federal government is supposed to transfer subsidy money over to insurers. But this is the system that Chao said hasn’t been built yet.

Though HHS has emphasized alternative means for individuals to enroll in plans directly through insurers, the technology isn’t in place for insurers to do so reliably. And it’s especially complicated for those who qualify for subsidies, because insurers don’t want to sell policies to individuals based on an inaccurate estimate of the premiums.

Late Friday, HHS announced that it was launching a “pilot program” with some insurers in Florida, Texas and Ohio to test a new direct enrollment feature."

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Author:

Philip Klein

Commentary Editor
The Washington Examiner