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  5. > Vital Signs - Health Insurance Exchanges: Real-Time Analyst Insights on HIX September 2013

Vital Signs - Health Insurance Exchanges: Real-Time Analyst Insights on HIX September 2013

  • October 2013
  • -
  • Frost & Sullivan
  • -
  • 120 pages


Table of Contents

Given the importance of the changes from PPACA and the creation of the health insurance marketplaces, we are providing our online Frost.com blog on HIX in collected form for the month of September for ease of use by our subscription clients.

Call Centers to Play Large Part in Online Health Insurance Marketplaces
03 Sep 2013

There has been much focus, and rightly so, on the health IT infrastructure and the data hub being constructed to connect state insurance marketplaces with federal agencies for the process of vetting eligibility and enrollment starting October 1. But, some states are realizing that, quite possibly, the way to successfully sign up people without health insurance might be easier by giving these same folks a “lifeline,” that is, a way to call somebody, somewhere who can help explain everything.

Vermont has 45,000 uninsured residents it is hoping to attract to its state-run exchange. Connecticut has 344,000. And Washington state is focusing on 1 million state customers who do not currently have any health insurance. These states are launching call centers to help people navigate through the health insurance marketplace in less than a month.

California and Maryland also run their own insurance marketplaces and have already opened their call centers and are fielding calls in an attempt to educate, inform, and hopefully persuade callers to take advantage of the soon-to-be-live health insurance marketplaces. Health and Human Services (HHS) already has its own call center up and running (1-800-318-2596).

Vermont is launching with 70 call center “navigators” backed with a $2 million advertising campaign using TV, radio, and print advertising to enlighten state residents about Vermont Health Connect and who can use it. Customer Support Manager Kelly Barnier says her phone team can expect very basic and fundamental questions, like “What is the exchange?” and “Do I qualify for subsidies?”

A recent Kaiser Family Foundation survey of 1,500 California residents found that very few knew what to expect on October 1st, and the majority of those surveyed believe the Affordable Care Act was repealed.

HIX Final Rule Published – Covers Payment Details and Describes Appeals
05 Sep 2013

Late Wednesday night CMS released to the public the so-called final rule for health insurance marketplaces that “sets forth standards for agent and broker participation in government-facilitated insurance marketplaces.” It also requires qualified health plans that issue exchange products “to accept a variety of payment methods.”

This iteration is all about oversight. Much like the Carter administration’s efforts to dilute Medicare fraud by creating the Healthcare Finance Administration (HCFA) in the 70s, this new iteration of governance provides the standards that establish oversight of health insurance issuers. “This will include HHS’s focusing on ensuring compliance with marketplacerelated standards while preserving states’ traditional role in overseeing the individual and small group insurance market.”

The 300-page document also includes a listing of the numerous ways consumers can make payments, which is very good for making the process easier. The rule also establishes processes for challenging eligibility miscues due to the rights of applicants. It goes further to outline a formal process, including a formal hearing if the appeals process does not go the direction consumers hoped.

Washington State HIX Call Center Logs 900 Calls on First Day
06 Sep 2013
Calls began as early as 7:30 a.m. on Tuesday when Washington state opened its health insurance marketplace call center. The majority of callers had eligibility and enrollment questions. Using an online cost-estimate calculator available at www.wahealthplanfinder.org, residents seemed to be pleasantly surprised to learn of their anticipated eligibility for financial assistance.

Staffed with a total of 80 customer service representatives, the call center appears to be fully capable of assisting residents navigate through the enrollment and eligibility challenge that so many critics of the health insurance marketplaces fear will be an institutional failure come October 1st. Call center volume fell to roughly 650 calls on Wednesday, but inbound calls are expected to grow substantially as we draw closer to October.

In anticipation of this bubble, Washington state is offering an online email address where you can post questions as well. The call center hours are from 7:30 a.m. and run until 8 p.m. with a toll-free number: 1-855-WAFINDER (1-855-923-4633).

California Reports Health Insurance Marketplace Website is Tested and Ready
10 Sep 2013
Covered California, according to state administrators, has fully field-tested its online website, which is anticipated to enroll 1.4 million people in 2014. This puts to rest, at least for now, comments and concerns about the readiness of the state-run insurance marketplace’s online component, which will be used to enroll people in health insurance. Just last month state officials began hinting there may be some hiccups in the official roll out in October. But, those fears seem to have been removed over the past 30 days.

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