Q&A with Tanya Case
Some Oklahomans face Dec. 15
deadline to join a health plan
Q: President Barack Obama last week apologized to at least 3.5 million Americans who received cancellation notices from their insurance companies because their plans don't meet the standards of the Affordable Care Act. But there's another 300,000 Americans, including 859 Oklahomans, with cancer, kidney disease and other chronic illnesses who also could lose coverage, given the problems with new online insurance exchange healthcare.gov. Tell us about those people.
A: These vulnerable people are those who were turned down for health insurance before the ACA, which in January 2014 makes it illegal for insurance companies to deny coverage to people with pre-existing conditions. For the past three years, many have been covered by temporary, high-risk insurance pools created by the ACA. But they will lose coverage 11:59 p.m. Dec. 31, as the ACA becomes effective Jan. 1. To be covered on Jan. 1, they must enroll by Dec. 15. Many of the insurers are also requiring payment of the first month's premium by Dec. 15 in order for coverage to be effective Jan. 1. We have no way of knowing how many pool members have enrolled so far.
Q: Given the new marketplace (exchange) problems, what are you telling these people?
A: We remind them that they can enroll over the phone at (800) 318-2596 and that there are many things that they can be doing right now to get ready to get enrolled. It takes a while to shop for a plan because our high-risk pool members need to make certain that their physicians, their hospitals are in their plan because they use health care frequently, and they have very close relationships with their health care providers. Also, they have to do a lot of research into the plans' pharmacy benefits because they use very high-dollar drugs, and many of them use specialty drugs. So we've impressed upon them that they must make certain what the plan covers in regard to their pharmaceuticals and make sure that they choose a plan that covers their medications at a rate they can afford.
Q: What are the exact steps you are advising individuals to take to get enrolled for new coverage effective Jan. 1?
A: First, they need to determine if they qualify for cost savings for their premiums because if they don't, there is no reason for them to enroll through the new marketplace. They can enroll directly with an insurance company or use their insurance agent to help them enroll through an insurance company. To get an idea if they qualify for cost savings, they can use the premium subsidy calculator provided by the Kaiser Foundation at kff.org/interactive/subsidy-calculator/.
Second, they should find out what insurers are offering products on the new marketplace in their county. This website — www.healthcare.gov/how-much-will-marketplace-insurance-cost/ — provides this information and also compares the premiums among the plans offered, but it doesn't provide detailed plan information.
Third, they need to shop on each insurer's website or call each company that is offering products on the new marketplace in their county of residence. Participating insurers include Aetna, (855) 632-6271; Blue Cross and Blue Shield of Oklahoma, (888) 900-4384; Community Care, (877) 321-0022; Coventry, (877) 907-4044; and Global Health, (877) 280-5583. When enrolling through the new marketplace, individuals must provide names, dates of birth, and financial information for all individuals living in the household and Social Security numbers for those who are enrolling in a health plan, so it is important to have this information available when calling.
Q: That sounds complicated.
A: It can be. That's why we encourage members to use any navigators or certified assistance counselors who are located within their communities to assist them. If they have a relationship with an insurance broker or licensed agent, we strongly suggest that they work with them to help them. If they buy an exchange plan through an agent or broker, there's no extra fee.
PAULA BURKES, BUSINESS WRITER