December 5, 2014

Healthcare.gov: What Was Our Experience This Time?

A little over a year ago I wrote about our experiences with Healthcare.gov, the Marketplace health site. As everyone knows, the launch was a disaster. The system crashed and kept crashing for almost the entire enrollment period. I was able to get a policy to carry me from January until Medicare started in May without too many problems.

Betty was another matter. Her application and data were so messed up we finally had to fight our way through to the Resolution Center to resolve her situation. That is not easy to do. Those folks are protected from "customers" like the gold in Fort Knox. You can read about that fun time by clicking here.

So, billions of dollars and thousands of man hours later, what happened this year? Betty's insurance company was not offering the policy she finally got last year, so she had to go through the application process again. Certainly, things would zip right along, right?

Wrong. We got into the same mess this time around. The web site continually crashed the first two days it was opened, and only functioned sporadically after that for at least two more days. Betty's incorrect information from a year ago continued to haunt our attempts to complete an application. Her application was complete, then incomplete, then verified, then needed to be verified....exactly like before.

The folks on the phone can't do a thing: they use the same web site that anyone uses, so when it is in the toilet they are powerless. When it finally works, they are unable to fix something that is causing problems. Calling the 800 number only increases your frustration and does not solve a problem.

Like last year we tried the Advanced Resolution Center but the protective walls are even higher this time around. Those golden men and women who can fix a problem cannot be reached by mere mortals.

We were just about to give up and buy insurance through the health insurance company's web site, losing out on hundreds of dollars in tax credits, when Betty discovered a sheet of paper from last year's battle that included a user name and password that had been given to us by the nice lady who finally helped us.

With nothing to lose, I entered those precious letters and - we were in! Suddenly I was sailing through a new application and 20 minutes later we had signed her up for a new policy, with a small but welcome tax credit. 

Not so fast. Two weeks later and the health insurance company had not received the proper paperwork from the Marketplace. The fine folks at the end of the 800 number said they would have their technical people look at the problem but it could take up to 30 days. With the deadline for coverage only 2 week away that was a non-starter.

With time running out, we decided to skip the whole screwed up system and buy a policy directly from the company web site. Our costs will be substantially more than last year for Betty's policy, with less coverage and more financial risks to us (silver instead of gold). But, at least we won't face bankruptcy over a serious health problem.

The Bottom line: National news reports indicate things went much more smoothly than in 2013. A half a million people were able to go through the process and sign up in the first week.

But, that isn't true for everyone. Once your application gets fouled up by software glitches, you are in trouble. With only 30 days this year to get things done before it is too late to get coverage starting January 1st, there is no margin for error.

The call center people told me that at times the software was performing no better than one year ago. If you had told me that we would have exactly the same experience as 14 months ago after all the money, the effort, and the promises, I would have not believed you. But, for us, that was what happened.

Guess what: Betty has 4 more years before she qualifies for Medicare. Do you want to bet we will go through this same minefield four more times? Or, simply pay whatever the insurance companies want and skip the whole gut-churning experience?

Of course, if the Supreme Court decides tax credits are illegal then the whole for-profit healthcare system as it is now set up will collapse in 2016 under the weight of huge premium increases and no tax help for those not well-off. Betty will become one of an estimated 80 million Americans without health insurance. 

Won't that be something. 


Update: December 11th and Betty finally has coverage directly from the health insurance company...3 days before the deadline.




30 comments:

  1. What a discouraging scenario!! I might add that the system has been equally difficult for health care providers to navigate for payment of their services. One would think that there's enough expertise out there--somewhere--to clean up the mess.

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    1. I wonder how long it took for Medicare to be properly implemented, with the all the pieces working together.

      Your point about the difficulty for all sides of this program is a good one. I'm sure the health care industry is frustrated as well.

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  2. I called Health Choice insurance company (Az.) with questions before I signed into healthcare.gov and the rep offered to set me up while on the phone with him.Took about 20 minutes.A week later we got a request for more info (from the Marketplace ) since our 2013, 2014 and 2015 incomes are so different due to our early retirement. I got my info packet from Health Choice and I am on board, but the gov. says I have till Feb. 1 of my subsidy to get them some docs to show 2015 income.I am praying what I sent them is enough and that they do receive it and hopefully process things quickly. I am on a grandfathered plan with Aetna and if it expires and I CAN'T get the subsidy, I will pay LOTS more for insurance.I am certain our 2015 income will put us in the clear for a subsidy though --so I have to say overall it's been an easy process so far.. It IS possible to get the subsidy at the END of the year, AFTER you file taxes... but I want the subsidy as we go along.. I guess worse case scenario would be having to wait to the end and having to pay the full premium on our marketplace plan (which is twice what I pay Aetna right now!) A NEW Aetna policy would be about the same price as the Marketplace plan is advertising is their full fee (almost $1000!!!) With a subsidy our health insurance will cost very little for the same plan I have with Aetna right now. It SHOULD all be a bit easier, I suppose! I just DREAM of other countries where health care is an important citizen benefit. Come on America!!!!

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    1. My personal belief is decent healthcare should be like our educational system through High School. - available as a birthright. The simplest solution is an extension of Medicare/Medicare Advantage, but for some reason people love it for those over 65 but run in fear from it when it is for those under 65. Go figure.

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    2. I helped a friend of mine with a similar situation. He retired in 2013 and his previous income had no relationship to what he would be getting in 2014. His income in 2014 was entirely based upon investments. What we did was to assemble a package showing what he received in taxable income from each of those accounts in 2013, (using brokerage statements up until the time of submission) put that into a spread sheet indicating his estimated taxable income for 2014 showing all sources of income expected for the year. Then had to submit that, along with CA proof of residency, a letter for proof of social security number, a document showing the termination of insurance coverage from his employer, a letter from Aetna showing that his Aetna policy was ending at the end of 2013. After all that they did accept it and he received coverage and his subsidy.

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  3. Sorry to hear about your and Betty's travails once again, Bob. Unfortunately the administration is so eager to pump out any good news that they err on the side of being, let's say, less than truthful when it comes to things like signing up for the ACA. I hope they get it right for you next year, but I will not take that bet you posited in your blog since I don't believe they will.

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    1. I am pretty sure we will simply bypass the Marketplace next year. The minimal tax credit isn't worth the aggravation.

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  4. My husband is on Medicare and I have my own private insurance policy. I wanted to be able to keep my Dr. and have reasonable deductibles/co-insurance. I'm satisfied with this. Do you really need those subsidies? The tax credits have to come from someone else, your kids, my kids... It seems like you are doing fine financially and I wonder why you even need those. Betty would not lose her insurance if those are taken away. She would simply have to pay more, like I do. Your comment about 2016 and 'no tax help for those not well off' does not seem to apply to you. If you can camp for months, you can afford to pay for your family expenses. Sorry, but I disagree with you on this one. I'll pay my higher premium but don't want to cover everyone else's insurance, except the truly needy and I don't think you fit into that category. dr

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    1. The amount of tax credit is minimal and not worth the hassle for us. I certainly understand your position on the tax credit use, but I would argue that if we qualify for a tax credit there is no reason not to take advantage of it. It is no different from any tax break we may be able to use.

      But, rest easy. When this year ends so will our ability to use them.

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  5. My son never did get insurance last year. He was unemployed so the website wouldn't let him purchase a policy, but put him into Access. However, because he had money in savings, 401, etc. the state wouldn't let him have Access. He finally gave up.

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    1. Susan, it takes some patience..the system is new, but it can be so helpful..maybe he can just try try again rather than go uninsured? Good luck! It's worth it to keep trying!

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    2. What State? I would expect that he got shuttled into the state medicaid system because, not working, he did not show enough income. I would need the specific state to see what the state law says on the use of assets in determining medicaid coverage. There was language in the law about assets not being included in some determinations but would have to check specifics.

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    3. State of Arizona. Access is the name for Medicaid here.

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    4. I just went through the Arizona data. They do not look at assets, only taxable income, so the fact that he has a 401k and money in savings should not block him from the state Medicaid system. One of the changes of the law was the removal of assets from consideration for getting coverage, it is only based upon household income. So something is not right. Also Arizona is one of the states that expanded medicaid so it should be open to anyone making less than $15516 this year.

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  6. I disagree with anonymous.Health care costs in this country are a crime. Our statistics on keeping healthy are also pretty bad.. our contry does NOT have the "best" system or outcomes!! With all the taxes collected, and with big corps being given such tax breaks and then DENYING employees fair benefits..YES! We need those subsidies..actually we need government given health care, in my opinion!! I would be paying over $1000 a month for NOT VERY GOOD INSURANCE coverage,without some assistance, and we are retired now.. I am sure this is a hot issue but I know MOST FAMILIES DO need help with this!!

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    1. See my comment to the anonymous person above. While I disagree with her, I certainly understand her feeling and respect her right to state it.

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  7. Corporations (including health insurers and big pharma) own Congress. Nothing will happen to improve middle, working and lower class access to health care until things implode. We are getting closer.

    Rick in Oregon

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    1. If the Supreme Court decides against tax credits in most states next year and Congress doesn't pass a patch, then the imploding you refer to is right around the corner.

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  8. Last year I spent hours working with Cover Oregon, which never did work. They finally processed the application manually after many, many hours of phone conversations. Then I had to work with the insurance company, because they didn't receive the information. Again, they finally called Cover Oregon and manually got the approval. It was awful!! Oregon gave up and is now on HealthCare.gov. On Nov 15, I applied and my application went through and was approved in less than 30 minutes! I thought everything just might work this year---WRONG! It has now been 3 weeks and the insurance company has not received the information from Healthcare.gov yet. I finally talked to someone there yesterday who is elevating my application for resubmission, but time is running out. I will be on the phone again next week, and every day until it gets resolved. It just totally sucks!! Without the subsidy, we would go uninsured, as we can't afford $900 month for an extremely high deductible policy. I am so frustrated - again!! At least I do have a letter from Healthcare.gov that validates my subsidy amount - that is better than last year. I can just buy insurance, but it will put us in the poor house. We already paid $1000 month for the first 3 yrs we were retired. Last year, we only paid $102 per month and will pay $139 per month this year, if it ever gets communicated to the insurance company. I am almost 62 and my husband is 60, so we will have to deal with this for many more years! I agree with you - Just expand Medicare to everyone and increase the current medcare tax to pay for it. It would cost a lot less than what we all have to pay now.

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    1. Your situation sounds so similar...Betty's application sat somewhere in the databank of healthcare.gov but was never communicated to the insurance company. Without the connection they could do nothing. After 2 weeks we had to give up and pull the plug. She only has until the 15th to get things approved so coverage doesn't lapse.

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  9. Most of my career was spent in government, which provided wonderful health care for pennies, even for retirees. While the work had trying times, I was always amazed at how employees would have a fit when premiums increased $1/month. Yes, our work could be frustrating - it was either crisis or some stupid assignment going nowhere - but our paychecks never bounced, the business didn't move overseas. It would always take so long to work through layoffs, that the economy would bounce back & then make them unnecessary. People can lose touch with what their neighbors endure, including those administering this health care program.

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    1. I remember once my parents complained when their cost for a particular drug went up $1 for a 60 day supply. You are so right - folks sometimes are so isolated from the cost that most others pay there is a loss of perspective.

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  10. Sigh.
    We need universal health care.
    It really upsets me that the people who are most against universal care are those with Medicare!
    I hope you try again next year. I believe anyone qualified should get tax credits!

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    1. I hope the Marketplace opens earlier so there is more than 30 days to get through all the hoops and obstacles.

      I will never understand how people can think a Medicare system is so wrong until you turn 65...then it is a godsend. That is beyond illogical.

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  11. I somehow lucked out by calling the INSURANCE COMPANY before I went online to healthcare.gov.The insurance company in Arizona, Health Choice, had me talk to a rep who did all the signing up FOR me.. on the phone with him, HE set up my account in healthcare.gov and also applied for the plan I wanted with Healthchoice.In a week's' time I got my notice from the MArketplace about the subsidy approval, yet also requesting more documents which I sent immediately. Same week I got my package from Healthchoice about my benefits. Evidently I am covered for Jan and Feb.. and if docs are approved, the rest of the year.I am sure our income will qualify us. Going to the insurance company FIRST was very helpful.I had called just to get info but they helped me all the way-- now, fingers crossed on the docs I sent.

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    1. You did well, especially considering the rural nature of where you live. Usually such a setting means very few choices and less than robust coverage.

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  12. Prior to the implementation of the law I had a policy costing me $305 a month for a high deductible policy that had a maximum annual out of pocket of $3500 per year. Basically I was responsible for the first $3500 and the policy paid everything else. It had very good out of area and even foreign coverage. I liked it because I travel out of my home county about 80 days of the year.

    After the law that policy went away, did not meet the requirements of the law. Now my policy runs $700 per month, has a maximum out of pocket of $5000. Will not cover out of network. Will not cover out of area except emergency room, with high co-pay. Will not cover outside of the US at all.

    Now since I am retired, not drawing SS yet, and had a lot of after tax assets I can pretty much take whatever taxable income that I want (just leave stocks unsold and not withdraw from IRA accounts). So if I sold just enough to get about the California Medicaid level ($16,500) I could get a policy equivalent to the $700 policy through Covered California and get it $620 per month subsidized, leaving only an $80 payment.

    In order to cover a few million uninsured, it pretty much upset the rest of the system.

    I spent 20 years working in the pharmaceutical industry, either for the FDA or for a company. One of the things that I did in my last position as a VP was to review legislation to determine impact and to recommend what BIO (the Biotech trade organization) should take as its position. I have read the complete law. My comment then and my comment today is that it is a law designed to fail. However, it was designed to fail after 2016 when the government subsidies to insurance companies (covering any losses they have from the policies sold through the exchanges) expires and the true premium costs show up. The law basically contains language to build all of the infrastructure in HHS to run a single payer system. The cynic in me, after having spent a lot of time in Washington and dealing with legislation, thinks that the law in the first part was design to blow up the system of private and employer insurance (basically impacting 250 million to deal with 35 million of uninsured or under insured). Of that 35 million the majority still remain uninsured. Then after 2016 (interesting that the provision would expire right after the next presidential election) have the law as written fall apart and the last step to a single payer system passed. Of course that logic would have depended upon a democratic controlled congress and a democratic president. All of the problems with it to date show how poorly written it is and even more poorly implemented.

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  13. I never had to deal with the Affordable Care Act. I did have to deal with private insurance for 12 years, which I got thru my professional organization. It was kind of expensive -- about $800 a month for my individual policy -- but it worked pretty well and I never thought it was terribly overpriced. After all, medical bills are expensive, so you've got to expect to pay a lot for insurance. In my opinion, it's not the insurance that's overpriced, but the medical bills. Anyway, I recently got on Medicare, for about $400 a month, subsidized by all those (including me) paying a payroll tax. I've had no problems with Medicare ... so far. Hope it stays that way!

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    1. I didn't realize there was a wide spread in Medicare costs, Tom. I have a Medigap policy that cover everything Medicare doesn't (including foreign emergencies) plus Part D drug coverage and my monthly cost is $265. So far after several tests, office visits, and even a very thorough CT scan, I have paid nothing on top of that monthly charge. After many decades of being on the very expensive individual market, Medicare is a blessing.

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