In less than 100 days, Tennesseans and Virginians with no health insurance will get the opportunity to sign up for coverage in a federal health insurance exchange.
Both states opted out of running their own health insurance exchange.
And now President Barack Obama’s administration, through the U.S. Department of Health and Human Services (HHS), has begun a massive education effort for the federal health insurance exchange established under the Affordable Care Act (ACA), also known as Obamacare.
That effort includes a new HealthCare.gov website and a 24-hour-a-day consumer call center to help Americans prepare for open enrollment and ultimately sign up for private health insurance.
Enrollment begins Oct. 1.
Coverage begins Jan. 1, 2014.
The exchanges are expected to cover those who don’t have company-supported health insurance and low-income people on Medicaid. The federal government will operate a health insurance exchange in 34 states, according to the Government Accountability Office (GAO).
“Much progress has been made, but much remains to be accomplished within a relatively short amount of time,” GAO observed in a recent report. “(The federal government’s) timelines provide a roadmap to completion; however, factors such as the still-evolving scope of required activities in each state and the many activities yet to be performed — some close to the start of enrollment — suggest a potential for challenges going forward.”
Consumers participating in the exchanges will be eligible for tax credits and are expected to be able to choose from varying levels of coverage.
ACA mandates all eligible Americans should have health insurance coverage by the start of next year or face possible penalties doled out by the Internal Revenue Service.
“All the health care law does is make their (health insurance) coverage better and more secure,” Gary Cohen, deputy administrator for the U.S. Centers for Medicare & Medicaid Services (CMS), said in a recent conference call with reporters. “But this law is also about the 15 percent who lack insurance. When the ACA was signed into law in 2010, it carried with it a promise of expanding access to quality, affordable health coverage for millions of American families and small business owners. ... Every plan will be required to cover a comprehensive set of benefits from physician visits and hospital stays to preventive care and prescriptions. Discrimination based on gender or pre-existing conditions will be banned when coverage begins in January. Many families and small business owners will also qualify for a tax credit that can be used to reduce their monthly premiums. What this means is no matter where you live or what your situation is, you will be able to get the affordable coverage you need.”
Cohen noted the Congressional Budget Office has estimated 7 million Americans will enroll in the health insurance exchanges.
What the federal government hasn’t said is who the actual insurance providers will be in the exchanges. That information won’t be known until September, according to HHS.
In an email, Tennessee Healthcare Finance and Administration spokeswoman Kelly Gunderson said Blue Cross/Blue Shield, CIGNA, Humana, Coventry Health & Life and Community Health Alliance have filed to be providers in the state’s federal health insurance exchange. HHS did not supply information about the providers who filed to serve Virginia.
“There are no assurances on how many plans will be in each state’s exchange,” Gunderson noted. “The reason we don’t know for sure is that a plan could back out or could not meet all the regulatory and operational requirements at the state or federal level.”
Tennessee officials predicted a “tsunami of demand” during the initial open enrollment period — both online and by phone.
But HHS claims the re-launched Healthcare.gov will be the facilitator as the online destination for consumers to compare and enroll in affordable, qualified health plans.
“This isn’t a typical government website,” CMS Communications Director Julie Bataille said of Healthcare.gov. “It will be acceptable on mobile devices and includes a live web chat feature, available 24/7. ... People can point to the tab that says ‘Get Insurance’ and there is a visual representation of what the process will look like — four simple steps: Create an account, apply, select plan and enroll.”
Between now and the start of open enrollment, a marketplace call center will also provide information and, beginning Oct. 1, will assist consumers with application completion and plan selection using both English and Spanish. The call center will also provides assistance in more than 150 languages through an interpretation and translation service. Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.
Staff from HHS regional offices will conduct community events, while community health centers will also offer assistance, said Bataille.
Cohen promised: “We will be ready to go on Oct. 1.”