2014 insurance deadline is nigh

Millions of Americans, including thousands in Arkansas, have until Monday night to enroll in health insurance coverage for 2014.

The Monday deadline - midnight EDT or 11 p.m. CDT - applies to people who plan to buy coverage for this year on their own, rather than through an employer. The deadline pertains to Arkansas and more than 30 other states where the federal government set up health insurance exchanges.

Open enrollment in most states operating their own exchanges also ends Monday, although Oregon last week extended its deadline until the end of April.

At the Main Library in Little Rock, where outreach workers with the Central Arkansas Library System have been helping people enroll for coverage since Oct. 1, the workers said Friday that they had been busier than usual.

By noon, they had helped a half-dozen people, including Becky Bass, 61, of Maumelle.

Bass said she has been uninsured for about three years, since she quit her job as a housekeeper because of her arthritis.

In 2012, she was hospitalized with an ear infection, racking up a bill of more than $20,000 that she and her husband, Lester, are still paying off.

The couple said they were hoping to find coverage that would help them avoid such bills in the future.

But after filling out an application on healthcare.gov, they learned that Becky Bass would not be eligible for financial help to pay for the coverage.

Without a subsidy, premiums on the exchange for a 61-year-old Pulaski County resident range from $509 to $977, which the Basses said they can’t afford.

“I’m $12,000 in the hole because I couldn’t get insurance before,” Lester Bass said, referring to the balance on the hospital bill from 2012.

Becky Bass said she planned to appeal the determination that she was ineligible for the subsidy.

Under the so-called private option in Arkansas, most people who qualify for coverage under the state’s expanded Medicaid program - a single adult with an income of up to $16,105, for instance - can sign up for a plan on the insurance exchange and have the premiums paid by Medicaid.

Federal tax-credit subsidies are available through the exchanges to those who don’t qualify for Medicaid but have incomes below 400 percent of the poverty level - for example, $45,960 for an individual, or $94,200 for a family of four.

To be eligible for the tax credits, the applicant must not have access to employer-sponsored insurance that is considered affordable, meaning it would cost less than 9.5 percent of the employee’s income.

Family members who could be covered under the policy are disqualified from the subsidy, even if adding them would make the employer-sponsored plan unaffordable for the family.

That could be what kept Becky Bass from qualifying for a subsidy.

Lester Bass has insurance through his employer, Moses Tucker Real Estate. Adding Becky Bass to the company plan would raise the premium from just over $100 a month to more than $700 a month, which the couple said they can’t afford.

LAGGING ENROLLMENT

Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield, said about 25,000 people had enrolled in coverage that the company offers through the exchange or its national affiliate, the Blue Cross and Blue Shield Association, as of the middle of last week.

In addition, about 5,000 people had enrolled in unsubsidized plans with the company. An additional 63,000 people were in Medicaid-funded plans with the company as of March 1, she said.

Insurance companies are required to include all of their customers who sign up for coverage in the individual market in the same risk pool, meaning their medical expenses will be used to calculate future premiums. In Arkansas, that includes those enrolled in Medicaid-funded plans.

Even taking private-option enrollment into account, “the numbers are not as high as we anticipated,” and the average age of those enrolling is higher than the company expected, Greenwood said.

She added, however, “We expected this first year to probably be negative, just because there are so many unknown variables.”

She said enrollment had been increasing as the deadline approached.

“Hopefully that will continue through the end of the enrollment period, and the mix will be such that there will be more of a balance and an increase in those individuals under the age of 35 enrolling,” she said.

Mike Stock, chief executive of QualChoice Health Insurance, which is also offering plans on the exchange, said enrollment in his company’s plans, among those who did not qualify for Medicaid, had also been less than expected, and that the average age was higher than expected.

He said the company had not seen much of an increase in enrollment with the approach of the deadline, which he attributed to the low amount of the potential penalty under the health-care law for failing to maintain coverage.

For an individual, the penalty for those who lack coverage for more than three months in 2014 is generally $95 or 1 percent of the individual’s income above the tax-filing threshold of $10,000, whichever is greater. The penalty amount will be prorated for those who are covered part of the year but have a coverage gap of more than three months.

Those who would have to pay more than 8 percent of their incomes for coverage through their employers or the insurance exchange in their states are exempt from the penalty.

“The penalty will almost always be smaller than what the cost of insurance for a year would be,” Stock said.

MANDATE EXEMPTIONS

People subject to the penalty will pay it when they file their taxes next year.

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services has said it will ensure that the penalty is not assessed against anyone who signs up during the enrollment period that started Oct. 1 and ends Monday, even if their coverage doesn’t kick in until April or May.

Those exempt from the mandate to maintain insurance coverage in 2014 include members of American Indian tribes, people who have religious objections to purchasing insurance, and those who are determined by the secretary of Health and Human Services to have had hardships in obtaining coverage.

Cheryl Fish-Parcham, private insurance program director for the advocacy group Families USA, said people who qualify for hardship exemptions on the basis of their financial circumstances should request them now, rather than waiting until they file their tax returns for 2014.

That way, if the person’s situation improved and he no longer needed the exemption, he could request a special enrollment period, she said.

“It’s a good idea to file now even if you could wait,” she said.

According to the U.S. Census Bureau estimates, about 48 million Americans, including more than 470,000 in Arkansas, lacked health insurance in 2012, the most recent year for which the figures are available.

President Barack Obama said last week that 6 million people had signed up for coverage through health insurance exchanges nationwide, including about 1 million since March 17.

That total does not include people who have been approved for Medicaid in states that have expanded their programs to include adults with incomes of up to 138 percent of the poverty level, as allowed under the health-care overhaul law.

As of March 22, more than 106,000 people in Arkansas had been enrolled in the Medicaid-funded plans under the private option.

Enrollment in the exchange among those who don’t qualify for Medicaid, however, has lagged.

The Arkansas Insurance Department reported last week that 33,569 people who did not qualify for Medicaid had enrolled in plans on the exchange as of Friday.

On Friday, however, the department released figures showing that the total included 2,668 people whose plans were later canceled.

In addition, the department said 8,234 of those enrolled had not yet paid their first month’s premiums, and 95 had been late in making premium payments but still had active coverage.

HELP WITH APPLICATIONS

Arkansans can enroll through the online federal portal, healthcare.gov, by calling a federal call center at (800) 318-2596 or (800) 318-2596, or by mailing an application to the Centers for Medicare and Medicaid Services.

Medicaid applications can also be submitted through the state website, access.arkansas.gov.

Through contracts with other government agencies, nonprofit organizations and private companies, the state Insurance Department has hired more than 500 outreach workers who can provide one-on-one help with enrollment.

A list of the organizations is available on the department’s Health Connector Division website, ahc.arkansas.gov, which also lists phone numbers for insurance agents licensed to help with enrollment and enrollment events scheduled around the state.

Federal officials said last week that people who start the application process before the deadline, but are unable to complete it, will be allowed to finish enrollment after Monday.

According to a Centers for Medicare and Medicaid Services fact sheet for consumers, extensions also will be granted in certain circumstances, such as when someone was mistakenly enrolled in the wrong plan or when “a natural disaster - such as an earthquake, massive flooding, or hurricane” - kept someone from enrolling.

In those circumstances, a person can request a “special enrollment period” by calling the federal call center.

A person can also enroll outside of the open-enrollment period after certain life events, such as the loss of a job.

In addition, people who qualify for Medicaid are not subject to the deadline. They can enroll any time during the year.

Last week, federal officials said activity on healthcare.gov had already started to climb.

They said they had taken steps to avoid a repeat of the frustration that many people experienced during the first two months of the enrollment period, when the site was hobbled by software flaws and other problems.

The website now includes a “virtual waiting room” to help manage the flow of users on the website if traffic is especially heavy, said Kurt DelBene, a senior adviser to Health and Human Services Secretary Kathleen Sebelius. Users may also be allowed the option of being emailed when traffic is lighter, he said during a conference call with reporters.

“While we’re encouraging folks to sign up early, we know that people will wait until the last minute,” DelBene said.