July 26, 2013

New health insurance markets: Not like Travelocity

By Ricardo Alonso-Zaldivar / The Associated Press

WASHINGTON — You may have heard that shopping for health insurance under President Barack Obama's health care overhaul will be like using Travelocity or Amazon.

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Christine Ferguson, director of the Rhode Island health insurance exchange, takes part in a meeting at the Statehouse in Providence, R.I. The Rhode Island marketplace will postpone a feature that allows consumers to enter the names of their doctors and instantly find out what insurance plans they accept.


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But many people will end up with something more mundane than online shopping, like a call to the help desk.

Struggling with a deadline crunch, some states are delaying online tools that could make it easier for consumers to find the right plan when the markets go live on Oct. 1.

Ahead of open enrollment for millions of uninsured Americans, the feds and the states are investing in massive call centers.

"The description that this was going to be like Travelocity was a very simplistic way of looking at it," said Christine Ferguson, director of the Rhode Island Health Benefits Exchange. "I never bought into it."

"The bottom line is that with tight timelines ... states have had to scale back their initial ambitions for Day 1," said Paul Hencoski, leader of KPMG's government health practice, which is advising nearly 20 states. "A lot of the more sophisticated functionalities that might have been offered through the Web are being deferred to later phases."

When the markets first open, Hencoski said, "there will be a significant amount of manual processing of things that will later be automated." Translation: emails, phone calls, faxes.

The Obama administration, which will be running the markets or taking the lead in 35 states, has yet to demonstrate the technology platform that will help consumers get financial help with their premiums and pick a plan.

Officials say they always envisioned people would be able to apply in a variety of ways, from online to the mail. About 7 million are expected to enroll in the marketplaces by next year, and the administration says consumers will be pleased with the experience.

Also known as exchanges, the markets are supposed to transform the way individuals and small businesses buy private health insurance by increasing transparency and competition, bolstering government oversight of insurers, and injecting hundreds of billions of dollars in taxpayer subsidies.

The experience will be more like buying a new car than snapping up airline tickets on Travelocity or electronics on Amazon.

"Consumers see this as a serious product, and something that requires a serious amount of research," said Julie Bataille, overseeing the outreach effort at the federal Health and Human Services department. "It's something they see in a more serious way than (buying) an airline ticket."

It's a complicated transaction with different components, including arranging financing and picking the right product, each with its own choices and trade-offs. You may need a glossary of health insurance terms.

And there's another layer.

One part of the process involves applying for federal benefits — with consequences if you lie to the government, or maybe just make a mistake.

Another involves using your federal subsidy to pick the right insurance plan from among competing carriers and four coverage levels: bronze, silver, gold or platinum.

You'll log on to the marketplace in your state, or the federally run exchange, and set up a personal account. You'll enter information about yourself and your family, including Social Security numbers and household income. The exchange will shoot your data to something called the "federal data services hub," an electronic clearinghouse that pings Social Security, Homeland Security and the Internal Revenue Service to verify your personal details.

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