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First day of new exchanges tough to gauge, says Blue Cross

Agency didn’t see much activity because of problems accessing exchanges


October 01. 2013 11:47PM

By - mguydish@civitasmedia.com - (570) 991-6112




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WILKES-BARRE — With numerous problems apparently reported in accessing the new federal online health insurance exchanges that launched Tuesday, gauging the first-day impact of the change mandated by the Affordable Care Act was difficult at best.


“It’s like it was the opening day of baseball and nobody brought a ball,” said Paul Holdren, chief marketing officer at Blue Cross Northeastern Pennsylvania. “When actually launched this morning there was a lot less activity than anticipated largely because of people’s inability to connect with the federal system.”


Which, Blue Cross Leader for Health Care Reform Suzanne Fletcher said, was generally expected.


“It has not been an overwhelming day, or an overly surprising day,” Fletcher said.


Ready for callers


As an insurance company with high name recognition, Blue Cross had anticipated an increase in calls from people with questions about the exchanges, and “we prepared in advance to make sure we could handle these calls, and to reassure people that you have six months to enroll, and you have until Dec. 31 to enroll for insurance starting Jan. 1,” Holdren said.


“Some people thought they had to enroll today (Tuesday),” he added, “while some thought if they enrolled today they would have coverage today.”


Four companies are offering insurance through the new exchange locally: Blue Cross, Geisinger, Aetna/Coventry and Health America, Holdren said.


The number of plans offered may vary among companies, but all stick to a four basic levels the government has named after metals, with premiums rising as the patient pays less of the cost of services: Bronze, in which the patient is responsible for 40 percent of costs; silver, 30 percent; gold, 20 percent; and platinum, 10 percent.


But most companies offer a variety of policies within each level that spread the patients’ share around differently, Holdren said, typically by changing deductibles.


“We fashion plans in each category,” Holdren said, “Say one plan has a $1,000 deductible but after you reach the deductible you have to pay 40 percent, another one may have a $1,500 deductible, but you only pay 20 percent after reaching the deductible.”


Maximum expenses


The law also sets maximums for out-of-pocket expenses, Fletcher added.


“The bottom line is that, within a metal level, you will see some slight variations between companies and policies, but at the end of the day a person selecting a bronze plan is going to have to pay 40 percent,” he said.


As has been the case with insurance in the past, premiums vary based not only on what metal level and what plan within that level you opt for, it varies based on age on some risk factors. Asked for an example of the range of premiums shoppers would see in Blue Cross policies, Holdren said that, for a 44-year-old non-smoker, the lowest cost bronze plan would have a $4,500 deductible and cost $187.64 a month, while the highest priced platinum plan would have a $250 deductible and sell for $439.39 a month.


Other windows


People who have trouble getting into the exchange for Pennsylvania through the federal website healthcare.gov can usually visit the websites of the participating insurance companies to find out what plans that company offers, Holdren said. They can even buy the plan directly from the company if they believe they are not eligible for any tax credits offered by the federal government based on income levels.


But those who want a policy and believe they are eligible for tax credits still must connect with the federal site to get those credits, Holdren said.


The government has been setting up “health care navigators” to help people work through the system, but Holdren and Fletcher said they knew of no navigator in Luzerne County. There are, however, dozens of agencies in the area serving a similar capacity. A list can be found using either your city or zip code at local help.healthcare.gov.




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