Yesterday afternoon, the Center for Medicare and Medicaid Services (CMS) held a conference call with navigators, assistors and brokers on how to deal with the mass of people who have a loss of employer sponsored insurance Special Enrollment Period (SEP). CMS is not running a no strings attached Open Enrollment Period (OEP), as many insurers and advocates had wanted for Healthcare.gov, but they are applying a lot of lube to the administrative pathway to speed the standard SEP process along. The critical information is about 30:45 in:
“I do want to point out that right now the Marketplace is not requiring consumers to upload supporting documentation to verify their eligibility to enroll in a Special Enrollment Period. So instead, consumers may attest to that information that they provide on the application while they are applying for a SEP.” (MY EMPHASIS)
This is very similar to the announcement from the Idaho state-based marketplace last week. Attestation is sufficient with no documents that need to be uploaded after an individual requests them from an office unlikely to be staffed.
We are getting a massive lesson in administrative burden and administrative friction in the delivery of public benefits. Public benefits can be readily and easily available. Public benefits can be legally available and “accessible” after jumping through a lot of hoops. If a public benefit is easy to access, then lots of people will use the public benefit. If a public benefit is difficult to access, not many people will use that benefit. And the people who get a hard to receive benefit tend to be systemically different than folks who are blocked from access by paperwork barriers.
This applies to food stamps.
This applies to voting.
This applies to Medicaid.
This applies to college financial aid.
And it applies to to ACA special enrollment periods as well.
Healthcare.gov’s Idaho’s removal of a documentation requirement and replacing it with an attestation dramatically reduces the administrative burden for people who have lost insurance. This is a good step to increase enrollment and provide some financial protection for folks who have gotten hit hard right now.
spartan_green
I am curious about people who bought marketplace plans and have now lost jobs. Can the government subsidies be adjusted? What about changing your plan altogether? My daughter and I have plans, but now our business is permanently closed. She did not qualify for a subsidy this year. Can that be changed? I took a plan with a high deductible that doesn’t give me much coverage. Can I change that?
Aimai
I work for a small (500 person) health care organization which provides both medical and psychiatric care to impoverished people and people with psychotic disorders on an outpatient basis, we also run multiple group homes for addicts, people with mental illness, and persons who are considered DD. We moved rapidly online but that only happened because all our paperwork had to include these attestations and that only happened because my managers could get clarity from insurers and DMH that they would accept these attestations. Now we use them for releases, for our own Covid-19 self evaluation, etc…etc..etc…
To your greater point all of these services should be opt out, not opt in. Everyone should be signed up for health care and for voting and then have to attest their way out.
Vhh
OEP = ??
Pls hold the jargon.
Steeplejack
@Aimai:
“[. . .] persons who are considered DD.”
What is DD?
David Anderson
@spartan_green: Good set of questions. If your income changes enough to become qualified for premium tax credits or CSR eligibility, you can switch plans. If you bought an off-exchange QHP (ACA plan) without subsidies, you can switch plans to an on-exchange plan.
https://www.healthinsurance.org/special-enrollment-guide/a-change-in-subsidy-eligibility-changes-your-options/
I will have a longer response tomorrow morning as this is a great question.
David Anderson
@Vhh: Updated…
Nettoyeur
SEP, OEP, DD … the post is unreadable to all but medical insurance über-nerds. Even in very technical publications, it is required (by reviewers, editors…) to define all acronyms when they are first used.
satby
This is good news for people.
Personally, now that I’ve spent a few hours over the last several days trying to make sense of and compare Medicare Advantage vs Medicare Supplement plans* to decide what I should sign up for, I’m going to bitch slap into a coma the next yahoo that says “Medicare for all” to me.
* The wildcards are monthly cost and coverage vs desire to travel potentially out of the U.S. once the covid crisis is over. But that won’t be for a year or more, and I turn 65 next month, and some of your choices seem to be locked in for life. Health care insurance in this country sucks.
Ohio Mom
DD is Developmental Disability, such as ID/Intellectual Disabllity (the disability we used to call Mental Retardation but we don’t say “retardation/retarded” anymore), Cerebral Palsy, Autism, Spina Bifida, rarer genetic conditions like Prada Willi, Williams Syndrome, etc. acquired BEFORE adulthood that impacts functioning.
So if you acquire ID as a four year old ingesting lead paint chips, you are developmentally disabled.
But if you lose cognitive brain functioning from a hit on the head or a brain tumor as an adult, you are just plain disabled. Also of note, age of onset of disability can make a big difference in the social service supports ($) one is eligible for.
Developmentally delayed refers to young children who are not reaching typical developmental milestones on time — say a toddler who isn’t talking on level. Are they showing the first signs of a serious, life-long disability, or do they just gave an idiosyncratic developmental arc?
Another example would be the child who never crawls but one day walks. Weird maybe but in the end, irrelevant if no other anomalies present.
”Delay” basically means, There may or may not be a disability, we’re waiting for more information. It’s an important designation because young children in this category can get free help from birth to three, such as speech therapy, OT and PT, and are eligible for public preschool starting at age three. Early intervention can make a huge difference and the federal government recognizes that and helps fund it.
Yes, I am a Disability Mom who has been to way too many workshops and conferences.
Steeplejack (phone)
@David Anderson:
Thanks.
Ohio Mom
Satby, I went through the Medicare decision process earlier this year. It is a gauntlet. Really confusing and I don’t know how older, addled seniors manage it.
I got help through the OHIP office (an Ohio state agency): 1-800-686-1578. They hooked me up with a local trained and certified volunteer who met Ohio Dad and me at the library and walked us through all the decisions we would need to make.
Obviously I don’t know how this would work in the age of Corona, maybe they Skype or Zoom?
I went with Traditional Medicare with a Supemental Plan N from AARP.
artem1s
So how long do you think it will take the Heritage Foundation to bring a lawsuit on behalf of some GOP yahoo governor to block a Special Enrollment Period. And Roberts to announce that he’s opening up SCOTUS to overrule a lower case ruling by a Lie-iberal activist judge?
Sure Lurkalot
Satby and Ohio Mom: I too set up an appointment with my state agency and it was all done by phone.
I always planned to go straight Medicare with supplementals…D for meds and I picked G for the coverage gap. IMHO Medicare Advantage is private health insurance created to undermine Medicare. It seems that its tight networks would make even domestic travel riskier. But many of the plans roll up what looks like comprehensive coverages like eye and dental care, gym discounts, etc. until you actually use them…and realize that the add ons don’t cover much and are purchasable elsewhere.
But everyone’s situation is different. So it’s good to research ahead of time by visiting the Medicare website and utilizing your state’s resources.
satby
@Ohio Mom: thanks! I’m comparing online, but too many of them yesterday (well, ok, 3 of them) suckered me into submitting my phone and email before showing me comparisons, and then never showed them, just started calling me. I’m wavering between G and N myself. And it’s going to cost about double what my ACA costs me, so I’m not a happy camper. Especially since I plan to spent many months per year not even in this country once there’s a vaccine for covid. It’s just insanely unnecessary how complex it is, just to accommodate private insurance companies.
satby
Yeah, that concerned me too. I have places I want to see here in the U.S. too.
satby
Anyway, to sum up: already hate Medicare and I’m not even on it yet.
Sab
@Ohio Mom: I didn’t get help but that’s what I got also. Heartening to know I might have guessed right.
My husband has medicare advantage through our local hospital/insurance chain. We had hoped to travel with retirement (ha-ha). He has spinal issues that require months ahead scheduling for treatment, so it is mostly in network and always local. I have heart issues, so my stuff is usually an emergency and I need a national network if we were to travel ( ha-ha.)
Sab
@satby: Having gone on medicare last year I agree with you wholeheartedly about bitchslapping members of the medicare-for-all crew. I am grateful I have it, but it certainly doesn’t feel like I am in Scandanavia for healthcare.
Sab
@satby: My husband just had his first tele annual checkup and it was hilarious in the age of corona lockdown. All the questions were aimed at evaluating his mental health as a senior. “Of course I am socially isolated. Of course I have someone else doing my shopping and errands for me. The governor told me to.”
Uncle Cosmo
Absolutely – that’s not only good style, it is absolutely essential if anyone not already an “übernerd” is to make head or tails of the text. But that’s never fazed Mayhew before – doesn’t seem to bother him that he gets next to no comments on his posts because no one understands them. (Or for that matter this blog’s worst offender, Hi Ho Silverman, though he will, if asked very politely, share definitions upon occasion.)
I’m not sure if they just can’t be bothered, or if they think every acronym & obscure phrase tossed out at the readership is another way to certify their claims of arcane knowledge. Probably changes with the weather.
Cole ought to (gingerly) remind them they’re not addressing an übernerdy conclave here. But he won’t – he’s too invested in having “experts” here & too afraid they’ll stalk off in a snit unless they’re permitted carte blanche.
(Personal note: Shortly after I joined a major defense contractor in the late 1970s I was sent to help draft a test equipment proposal. The Lead Engineer gave me a 5-minute rundown on what they were doing & what they needed me to do. “Is that clear?”
“No.”
He started screaming curses; I cut him off. “I’m new to this business. Provide me definitions for every acronym you just tossed out & then make the same presentation & I’m confident I’d understand. But not unless, and not until.“
It was a seller’s market for technical expertise, & they were desperate; I got that list, and I did help them out.)
satby
@Uncle Cosmo: David has often commented that some of his posts are sort of thinking out loud pieces and he realizes that it can be a bit opaque to regular non medical jargon types. He’s always been very responsive to requests for clarification or help though. We’re very lucky to have him posting here.
spartan_green
@David Anderson: Thanks David. I’ll be watching. Now if you could help me with unemployment insurance. . .
Sab
@Uncle Cosmo: I agree with Satby above.. David seems to be using this forum as a way to connect with lurking uber nerds in his field. I am fine with that and am grateful that he lets us in on it.
I usually don’t understand a lot of what he writes, but when I do light bulbs go on.
There is a lot of chrystal clear bad info out there. I would rather have the opposite: musings from a bright intellectually honest man feeling his way through the murky information on this new virus aas he and his fellow health and insurance professionals try to deal with it and communicate with each other.
My current feeling is, if the news you get seems clear and easily understandable, it is probably propaganda not information.
Duane
Administrative friction is a polite way of saying “Republicans are screwing us.” How decent of them to offer lubricant, but the screwing will continue until morale improves. Sadists gotta sadist.
Ohio Mom
Re: Traditional vs Advantage Medicare.
What sealed it for me was learning that if you sign up for Traditional first thing, the Supplemental plans can’t hold your medical history/pre-existing conditions against you.
If you sign up for an Advantage Plan, and years later you want to be seen by a doctor not in the network — say you develop a heart condition and you want to go to the surgeon who does the minimally invasive procedure, or you want to go to the oncologist who specializes in your type of cancer — at that point, if you want to switch to Traditional Medicare, the Supplemental plans can charge you a lot more or even refuse to underwrite you.
There are exceptions to all this and the rules sometimes change — you are flying blind and forced to be your own actuary.
Ohio Mom
I will be forever grateful for David helping my family (off line) through a health insurance thicket earlier this year.
I’m with Sab and Satby. I’m kinda proud “my” blog has real experts writing, instead of what I see elsewhere in blogtopia.
Sometimes I challenge myself to follow along these posts, sometimes I’m having a “my brain already hurts” type of day so I skip right to the comments.
I have learned some things and I certainly have grown in appreciation Iof how difficult health policy is. One thing I learned is that even places that have the single payer systems i pine for have Mayhew/Anderson types crunching away and asking the big questions.
TL;Dr: Please Carry on, Anderson!
Poe Larity
Moving a young cousin with a life change from CA to FL on healthcare.gov took 5 calls with an hour+ wait, a State that had no recieved records (2+ additional calls with them), 14 day wait to escalate. This is with us having all his docs ready and uploaded due to prior history.
Kid would have given up on day 1, fortunately his dad and I have this thing where we are at home all day, good internet and unlimited phone plans.
frosty
@satby: That was my reaction exactly. Medicare is an awful kludge. It took me two months to figure out if I could use my Maryland doctors with a PA Med Advantage plan using out-of-network reimbursement*. I couldn’t get a straight answer from anyone. We went with Medigap.
* the system is set up by state assuming your docs are where you live. If you’re a mile from the border it doesn’t matter.
frosty
@satby: FYI we went with Medigap G. Extensive travel plans was one of the factors. Also that our (Maryland) dentist doesn’t take Medicare.
WhatsMyNym
@satby: Hope you see this.
The best review I read about the difference between the options was here. NOTE: that was written by a broker and they like Cigna, but it is still very informative in the useful way.
I ended up choosing Cigna’s G plan for my mother and they have been very good; no complaints at all.
ETA: didn’t have an Advantage Plan option in this county originally. Glad I didn’t get one because of the different specialists my mother has had to use around the area.
satby
@Ohio Mom: @frosty: @WhatsMyNym: Thanks all, I’m leaning G plan myself… But Medigap is the way I’m going to have to go. If I get seriously ill, I’m heading back to Chicago’s hospital system, not staying in IN. So Advantage plans are useless to me.
David Anderson
@Nettoyeur: The acronym was spelled out at first usage.
@Uncle Cosmo: It was not my intent to be opaque. When I write with editors and a formal review process, I write differently than when I write things before the first cup of coffee for a blog that is still the #1 search result for the phrase “skull fuck a kitten”.
I somewhat assume that as part of a 2,000+ post conversation on US health insurance being a kludged up mess on the best days, that re-defining terms is not needed in every post. I’ll try to either link to definitions or provide short,plain English definitions going forward.
WaterGirl
@David Anderson:
Thanks for this. I laughed out loud.