Just a couple of reminders on what to expect from the data during the 2015 Exchange open enrollment period as I have the kids home for a snow delay so I don’t think that I can think this morning.
1) Deadlines matter.
We saw this in 2014, we saw this in Massachusetts in 2007, we see this every year with Medicare open enrollment but deadlines matter. Most people will procrastinate until the end and they are forced to make a decision or send a check in. Last year we saw roughly half of the enrollment activity happen in the last six weeks.
2) Different deadlines are in play
There are three sets of deadlines; two major and one minor. The first major deadline is December 15th plan selection. This deadline will allow people to start their new policy on January 1, 2015. That will provide either continuous coverage from previous policies or start their new coverage as soon as possible. The other major deadline is February 15th. This will start coverage for March 1, 2015, and it is the last day that regular coverage can be bought for the year unless there is a special qualifying event. The minor deadline is January 15th as that will allow people to start coverage on February 1st.
3) Two different populations are in play.
2015 is very different than 2014 in that last year everything was brand new to everyone. This year, there are 7 million people who are looking to renew their coverage. I think we should see the vast majority of these people renew by December 15 as they want to keep their coverage. Losing coverage for a month would be a break from their new routine. The other population is far more similar to 2014’s general Exchange population in that they are switching from no coverage to coverage. Procrastination is more likely here, so I anticipate more people signing up after the New Year than before the New Year.
4) Self identified sick get covered earlier
People procrastinate unless they have a damn good reason not to. That is, to me, a reasonable assumption about life. The early renewers and the early new enrollees are statistically different than the entire population of renewers and new enrollees in that they are far more likely to be sick with chronic conditions. Insurance lets them knock a problem off their to do list. Relatively healthy people will delay. The take-away is that we can not make good population health guesses based on November enrollment activity.
5) Four steps of web activity
a) See the exchange
b) Log into the Exchange and look around
c) Put a health plan in the shopping cart and check-out.
d) Pay the premium
Right now we can track C as payment for January 1st coverage is not due until the week of Christmas. March 1st coverage won’t see payment due until February 21st. There is a big lag between choosing a plan and the last day possible to pay for that plan. There will be some drop-off. Charles Gaba used a 12% drop rate for his purposes.
satby
I should be looking into renewing, but I think my coverage lapsed when I couldn’t even pay my subsidized premium. Do I just go onto the site and put in my even more reduced income for next year?
terraformer
You know, my employer required us to make our health care selections by Nov. 14 – the day before healthcare.gov opened up. Sure, I could look at potential plans and prices before then, but I couldn’t actually sign up for coverage until the 15th.
So my question is, I see that there appear to be at least a couple of plans on healthcare.gov that look better than what I’m getting via my employer (e.g., lower deductible, lower monthly payments for similar coverage, similar out-of-pocket annual maximum). But, since I had to choose coverage through my employer already – and I did – can I just drop my employer-based coverage without penalty to select another plan via healthcare.gov? Or am I locked in to my employer’s plan?
Also, when I go into the healthcare.gov plans, I add myself, my spouse, and my child. Why then do all of the plans that come up specifically indicate “2 people covered”? Is my child automatically assumed to be covered or something? Why isn’t my child coming up so instead the site says “3 people covered”?
Mike E
Oh, and again I have no idea what my income will be since my two part time jobs are supervisor dependent–meaning, one won’t/can’t predicted how he’ll use me in the next month let alone an entire year, and the other is a nonprofit that uses me as contract worker (1099 misc) and although they can ballpark it, this too can change.
DHHS wants precision. I guessed for the Dec ’13 sign up by adding 10% to that year’s haul and will prolly exceed that pulled-outa-my-ass mark by another 10%. This year? Who knows. I’ll prolly have to let it go until the Feb deadline to know for sure. How do people like me–no full time status, cobbled together income–get coverage thru this system?
Good thing I have my colonoscopy scheduled in 2 weeks; I’ll get in a dermatologist appt in too just to rule out skin cancer before the end of this year.
Mnemosyne
@Mike E:
See if you can track down a Health Navigator for your state, but IIRC the worst case scenario is that you get a bill at the end of the year (probably more around tax season) if your actual income exceeded the income you estimated when you signed up. I think that if you overestimated your income, you can get a refund if you overpaid, but check with an official person if possible.
gussie
I’m with you, Mike. I have no idea what my income will be. I presume if I guess too high, the extra money I spend will come back to me, and if I guess low, I’ll get hit with a huge tax bill?
Richard Mayhew
@satby: Yep, go in, enter your new income and expected income for 2015. If there is something that makes sense for you, you can sign up for it. If it is still too much and you are either in a non-Medicaid expansion state or make just above the cut-off point for Medicaid, you probably will qualify for a hardship exemption on the mandate. But go in, look for 15 minutes and see what is available.
Richard Mayhew
@terraformer:
Anyone can shop on the Exchanges. The limitation is that families where at least one person is offered affordable minimally adequate coverage for a single person via work is not eligible for subsidies.
#2 You can decline your employer coverage as almost all open enrollment windows have a 2 week correction period. Talk to HR if you elect to buy coverage on the Exchange.
#3 Your kid probably qualified for CHIP or Medicaid, so that is why the website is assuming you are only buying coverage for two people. Talk to a navigator ASAP to clarify the situation as some states will cover all kids in CHIP, others may only cover kids who don’t have a private market alternative available to them.
Richard Mayhew
@Mike E:
Mike, make a good faith estimate/guesstimate/wild ass guess about your 2015 income. If as the year continues, your income starts to deviate from that wild ass guess, log back into the Exchange and update your income guess.
The IRS will reconcile your income estimate which is what drove your 2014 subsidy with your 2014 tax return. If the tax return has more income than your estimate, the IRS will take some of the extra subsidy back.
The key here is good faith estimates need to be made. Your system seems to be good faith in my opinion.
Richard Mayhew
@Mnemosyne: Depends on how low you guess. The IRS is limited to taking back no more than $2,500 as long as you were eligible for some subsidy. If your income goes over 400% FPL, you owe the entire subsidy. If you’re off by $1,200 and you are still within the subsidy zone, you’ll owe a $150… so it depends on how much you thought you were going to make, whether or not you are still subsidy eligible and how much you actually made.
VFX Lurker
@Richard – I made too much to qualify for subsidies this year, but due to circumstances I expect to qualify for subsidies next year.
If I buy insurance on the exchange without subsidies for 2015, and I end up qualifying for subsidies at the end of the year, would I receive a subsidy on my 2015 tax return?
LongHairedWeirdo
DO NOT DO THIS IN THE STATE OF WASHINGTON UNLESS YOU CAN GET SUBSIDIES.
In Washington State,
1) get on the exchange
2) see if you’re eligible for subsidies
3) if so – continue with the plan above.
4) If not – find a good plan *CALL THE INSURANCE COMPANY DIRECTLY* and buy the plan from them. wahealthplanfinder.org could fuck up a pillow fight. Don’t work with them unless you get subsidies.
satby
@Richard Mayhew: Thanks Richard!
The Raven on the Hill
Thank you for the reminder; I didn’t realize the deadline was less than a month away. Washington’s paperwork also indicates a deadline at the beginning of December, but I am not sure if that is real, or just bureaucratic wishful thinking.
This year our projected income is looks good, but one never knows. So my thought was to stay in the Exchange, and at least get a tax credit if things go south. Then I looked at my current insuror’s “gold” plan. It’s a “get taken to the wrong ER, get taken to the cleaners” plan–there is no out-of-pocket maximum for out-of-network care. It’s got copays for everything, including routine office visits. This is poor coverage. But if we buy a plan outside of the Exchange and our income comes up short, we come into the exchange part way through the year, and our tax credit is scrod, or some other sort of fish.
My impression of the Washington Exchange is that it is competent but understaffed. Last time I dealt with them, it took them over two months to process an income change. I still have outstanding reimbursements, months later.
The Raven on the Hill
BTW, draft ACA tax credit forms are up on the IRS site. The two forms are 1095-A, which your exchange sends to you, and the 8962, which you send to the IRS.
Have fun, wonks!