The Affordable Care Act – broadly known as Obamacare – is a sweeping reform of the American healthcare system that became law in March, 2010. One of its key features is the encouragement of insurance marketplaces, called Health Exchanges, at the state level. Fourteen states have chosen to operate Health Exchanges within the Obamacare framework, and each hosts its own website through which residents shop for and obtain health insurance coverage. Residents of the remaining 36 states participate in the federally operated program which can be accessed through the healthcare.gov website.
Unless you’ve been living in a cave, you are aware that healthcare.gov – which launched on October 1, 2013 – has had a very rocky start. It has been the source of significant frustration for consumers trying to log on and conduct business, and manna from heaven for pundits, Obama critics and late-night comedians.
Problems with the rollout of healthcare.gov have been well documented, including the inability of consumers to log on and transact business, despite trying to do so for hours, days or weeks. But how's the website performing now? By all accounts, performance is much better. It's more user-friendly, system capacity has been radically increased, and the need to input your information before accessing prices has been eliminated. However, several important concerns remain. Among them:
- Information Transfer – During the first few months, some people's 834 forms (forms containing vital sign-up information) were incorrect or not forwarded to the insurance company. In one mid-October period, 15% of enrollees had problems with the 834 transfer. If the insurance company doesn't have your 834 form, you're not enrolled.
This has improved significantly — according to healthcare.gov, "missing 834's as a percentage of enrollment (are) now near zero" as of Dec 14th. Still, that's not the most confidence-inspiring language, and this emphasizes that it's extremely important to verify your information with the insurance company. Check the information on your insurance card, and if you haven't received the card within 10 days of signup, call to verify your status. It’s important to remember that your payments are made to the insurance company, not the website. Without a premium payment, you won't have coverage — regardless of what took place on the website.
- Security – While some security experts give healthcare.gov a poor grade, there have been no reported data breaches. You have no choice but to submit information if you are going to use the website — just monitor your credit regularly and be diligent for any signs of identity theft.
- Medicaid/Subsidy Assessment – When you input your financial information, the website calculates your qualification for Medicaid or subsidies for insurance, and acts accordingly. Some people are being told they are eligible for Medicaid or CHIP (Children's Health Insurance Program) and automatically enrolled — or so they think. Information is not reaching the state Medicaid agencies in some cases, and if you are in that situation, you are in limbo. The system does not know what to do with you.
You may be forced to purchase insurance outside the website or go without, since resolving the Medicaid status through the government side may take longer than the open enrollment deadline (March 31st).
There are other stories of incorrect assessment that send people on a trip down the bureaucratic rabbit hole. In all cases the advice is the same — check with your insurer or state Medicaid agency, whichever one applies.
- Change of Status – There do not appear to be provisions for modifying data such as adding a newborn, changing your marital status, losing a job, or other fundamental life changes. Any of these may shift the insurance plan for which you qualify. Navigators may be able to assist you, but in these cases it's wise to work directly with the insurance company and bypass the exchange.
While the healthcare.gov website has improved, there are still important problems to correct, and if you can, it's best to go directly to the insurance companies. If you do, however, the catch is that you won't be able to claim any subsidies for which you may be eligible. Which means if you are low income, your best bet is still to go through the exchanges and be as diligent as possible on verifying your status.
All complex systems go through rough startups, and healthcare.gov is no different. Despite these highly visible problems, the fact remains that 1.1 million Americans obtained insurance on the website by December 31. And it is slated to be further improved by the time the 2015 signup rolls around in October… we hope.