Raising the Curtain on Open Enrollment, Round Two

By Tricia Brooks, Georgetown University Center for Children and Families

The second open enrollment period for the health insurance marketplaces, or OE2, is mere days away. As I wrote in this blog and the related Health Affairs story, OE2 will be part sequel and part new production. Taking a peek behind the curtain, what can the audience expect on open day, November 15th?

Outreach and Public Awareness – The script will be more finely honed and outreach targeted to specific groups of people. Many stakeholders anticipate that engaging new enrollees will be harder given that these individuals chose not to buy a ticket last year. But much research has been conducted in 2014 to help pinpoint differences in the demographics of people who are uninsured but likely eligible, identify persisting barriers to coverage, and test messages that can move consumers to enroll, and these lessons are being incorporated in the new run of show. Collaboration and coordination among consumers assisters and other stakeholders may be more prevalent this round. For example, upwards of a dozen state networks of assisters are adopting Enroll America’s assistance scheduler, which will help coordinate access to help among the various assister entities.

Better Training for Assisters – CMS has improved its training and support for consumer assisters considerably, often drawing on key partners to give feedback on training content and help train assisters. In particular, training has featured images of various healthcare.gov screens and step-by-step training, although not quite as good as a full dress rehearsal. Still, funding for consumer assistance is woefully inadequate while assisters are expected to play multiple roles, helping their existing clients re-enroll while conducting outreach and enrolling new applicants.

Streamlined Application Process – CMS, which will operate the online box office for the marketplace in 38 states, has a new streamlined application that is expected to ease the process of enrolling for two-thirds of new applicants who have more straightforward family circumstances. But those who don’t fit the bill will be routed to the old application, which has had few improvements and will still present problems for individuals without credit histories to confirm their identity.

Increased Technology Capacity – At the federal level, additional capacity is slated to help avoid the frequent system crashes that plagued the early weeks during the first open enrollment. But demand will also be higher given that current enrollees will be using the same system to renew coverage along with millions of new applicants. And seven states will be testing new systems yet again, as Oregon and Nevada move to the FFM, Maryland adopts a new system, and four other state-based marketplaces are switching IT vendors.

Smoother Coordination with Medicaid and Issuers – It takes more than actors to stage a good performance, behind the scenes set changes, lighting and music have to be well coordinated. And that’s where things fell short in OE1. The electronic account transfer process between Medicaid agencies and the FFM wasn’t fully operational even at the end of open enrollment but should be more in tune this time around. States will receive twice weekly accounts from the FFM, but the readiness of state Medicaid systems to receive and process these transfers on a timely basis remains questionable in states that are still working through last year’s backlogs. Additionally, the back end functions for transferring data between the marketplaces and insurance companies should also make for smoother enrollment in a qualified health plan.

QHP Renewals and PTC Redeterminations – This is where the new production comes in. Most consumers are not required to take action to keep their premium tax credits and remain enrolled in their plans. But after boos from the audience, the FFM changed the script from promoting that “no action is needed” to encouraging consumers to update their information and compare the new QHP offerings before deciding to keep their old plan or switch. This is important to assuring that consumers have the most accurate estimated of premium tax credits and reaffirm their choice of health plans.

Tax Penalties and Premium Tax Reconciliation – Coinciding with the second half of OE2 is the tax season for filing 2014 tax returns; so what happens at tax time? This is when people who are required to file taxes and went without coverage will be assessed tax penalties if they do not qualify for an exemption from the individual mandate. This is also when individuals will need to reconcile the PTC (based on projected income) they took in advance to help pay for coverage with the final determination of premium tax credit based on actual income. Hopefully, there won’t be too many surprise endings, but we’ll have to wait until show time to know for sure.

Needless to say, there’s a lot involved in this production, and new critics and fans to please. The good news is that CMS has been very receptive to receiving and responding to input on needed improvements from consumer advocates, assisters, and other stakeholders. Such responsiveness will be key to tweaking the performance to gain more favorable critical reviews after the curtain is raised on OE2.

Editor’s note: This blog post was originally published on Georgetown University Center for Children and Families’ Say Ahhh! Blog.

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