Health exchange website testers learn about options

Heavy traffic and opening-day technical glitches made Washington’s new Health Plan Finder website difficult, if not impossible, to use Tuesday.

But if a group of volunteers recruited by The Spokesman-Review is any indication, the demand for decent health coverage is considerable.

The Spokesman-Review’s volunteers also made it clear, however, that it is not as easy to select a health insurance policy online as it is to book a hotel online – even if the website works. The pitfalls are significant:

• Does a policy cover a needed medication?

• Is the specialist who prescribes the medication in the policy’s provider network?

• Which hospital is in the policy’s provider network?

• How does the policy cover medical care that might be needed when the consumer is traveling away from home?

• What’s the wisest balance between a lower premium and a higher deductible?

• The enrollment window to purchase one of the new policies, for coverage in 2014, extends from now until March 31; outside this window, consumers may have to wait months for coverage, regardless of what medical needs they might encounter.

How can a consumer study the risks and make the choices?

In theory, the new insurance-shopping websites are supposed to make this information readily available so consumers can compare the competing health plans and make an “apples to apples” choice.

But it may not be that simple. The Spokesman-Review’s consultants recommended that consumers consult an experienced insurance broker, trained to ferret out the critical details. Brokers are licensed to help clients use the new website.

For Tuesday’s debut of the Health Plan Finder, www.wahealthplanfinder.org, The Spokesman-Review invited readers who need health insurance to give the site a try. More than two dozen volunteered, and five were selected as representing a variety of situations. Veteran health insurance broker Richard H. Denenny, recruited by the newspaper, welcomed the volunteers to his Spokane Valley office. Joining Denenny, and likewise donating her time, was insurance broker Jean Gulden.

The federal Affordable Care Act called for each state to have an insurance-buying website, as part of a multipronged strategy to make insurance available to more Americans. The law’s strategy also requires toll-free call centers and trained providers of in-person assistance.

These aid providers are trained to answer users’ questions, but only health insurance brokers are legally authorized to make recommendations for which insurance plan might serve a consumer best. Brokers, Denenny said, do not charge their clients a fee; instead, brokers receive commissions directly from health insurance carriers if a client purchases a policy.

Even though the new website was not working well, Denenny and Gulden were armed with detailed information about the new law and the insurance plans now being offered for sale. Joining the two brokers to offer information for the newspaper’s volunteers was Curt Fackler, who oversees an Eastern Washington network of in-person assistance providers.

These are the volunteers who showed up to learn about the new system and try the website, and here are their stories:

Shelly Watkins

Shelly Watkins, 53, has suffered from diabetes since she was 5. Deteriorating vision, caused by her diabetes, ended her 25-year career at Community Mental Health and as a hospital social worker. Today she has no health insurance. She lives on a modest disability pension from Social Security. Over the years she has had heart surgery, a kidney transplant, a pancreas transplant and a mastectomy. Drugs keep the transplanted kidney and pancreas going, although sometimes the pancreas gives out, she said, leading to diabetic symptoms. She takes 15 medications a day, one of them costing more than $2,000 a month. She contacted the manufacturer of her costliest medication, who agreed to provide it for a year at no cost.

Due to her medical bills, she lost her home and now lives with her sister.

After consulting with Denenny and Gulden about the coverage she could purchase on the Health Plan Finder, she learned that issuance of coverage is guaranteed and that she cannot be charged more due to her medical issues. Federal subsidies, based on her income, may reduce her monthly insurance premium to $11.

Watkins said, “I thank you so sincerely. This is literally life-saving for me. Not that I’m a drama queen, but I have actually sat and made funeral arrangements.”

Gulden, the broker, is no stranger to the cost of prescription drugs; she suffers from Crohn’s disease, she said, and must use a drug costing $1,700 a month. People who face high costs even with insurance, Gulden said, will benefit from the Affordable Care Act’s requirement for an individual out-of-pocket maximum of $6,350 per year, after which all costs must be covered. In these situations, Gulden said, sometimes a plan with lower coverage levels and a lower premium will make more financial sense.

Cathie Dennie

The owner of a small property-and-casualty insurance company, Cathie Dennie came with questions about whether the Affordable Care Act would make it possible for her to provide health insurance for her five employees. She hasn’t been able to do that in the past, she said, but would like to try.

The news was not good: Even though the federal law and the new websites are designed so small businesses can set up a coverage account for their employees, only one insurance company offered a small-business group plan for sale on Washington’s Health Plan Finder, and it’s only available in Clark and Cowlitz counties. Insurance Commissioner Mike Kreidler has called that a disappointment, but said he expects more carriers will step forward with small-business plans for 2015.

Denenny said insurance companies were “overwhelmed” just figuring out how to comply with federal law for policies to be sold in the individual market; policies for small-business group plans are riskier and more complex, he said.

As a result, Denenny and Gulden said, one of the best options for Dennie and small-business owners like her might be to offer employees a salary increase, which employees could use to purchase individual policies on the new Health Plan Finder. From Dennie’s point of view, they said, the increased salary would be a deductible business expense. Dennie, however, would have to absorb the cost of Social Security and Medicare payroll taxes on the salary increase. Small businesses like Dennie’s do not face a federal penalty if they cannot provide health coverage as a fringe benefit to their employees.

Dennie said she was feeling “a little bit discouraged” about what she learned.

Tim Steele

Recently retired after 27 years as a registered nurse, Steele is 54 and has no health insurance. Although he’s considering an extension to his former employer’s health plan under COBRA laws, he said he has not yet received the paperwork to do so, and is interested in the possibility of purchasing individual coverage on the Health Plan Finder. But he said the rates seem “crazy.”

Steele said he has no major health issues. After talking with Denenny about the tradeoffs between lower coverage levels and higher deductibles, he said he is leaning toward a lower-cost plan, possibly combined with a health savings account to help with some of the costs a lower-cost policy may not cover.

Becky Dickerson

With her husband Todd, Becky Dickerson, 43, owns a farm outside St. John, Wash. They have three children, ages 10, 12 and 15. Dickerson, with a laugh, describes herself as “insurance napalm” because she has multiple sclerosis. Until now she could not get an affordable policy on the individual market, so she buys coverage from a high-risk insurance pool offered by the state – an option that will disappear this year and be replaced by coverage on the Health Plan Finder. Dickerson’s own policy costs $800 a month and a separate policy for her husband and children costs another $800, she said. “We’re living the dream and getting screwed pretty bad,” she added.

Dickerson was the only one among The Spokesman-Review’s five volunteers who succeeded at logging on to the Health Plan Finder website Tuesday. She created an account, entered her financial information, and studied the policies that she and her family are entitled to purchase.

Dickerson faced some critically important choices, Denenny and Gulden said, in choosing among the plans: She requires costly medications and must make sure they’re covered. Also, she must make sure that the Spokane specialist who prescribes her medicine is listed among the providers for the plan she chooses. At that point, Dickerson encountered a glitch in the system: She couldn’t find her provider in the new site’s lookup function, apparently because the system’s built-in logic considered the physician to be located too far from Dickerson’s home. She telephoned the toll-free call center to clear up the problem – but the call-center worker who answered could not investigate because the operator’s computer could not bring up the balky website.

In the end, Dickerson concluded she might be able to get a policy for her entire family, including herself, with a premium of $1,411 a month. A federal subsidy based on her family’s income would reduce her actual premium cost to $288 a month.

“That’s huge,” Dickerson said. “We can pay for that 15-year-old’s college education.”

Her conservative husband worries, she said, that the new federal system might vanish someday.

That’s not likely, said Denenny and Gulden, but they believe if it ever did happen, government surely would have to create something else.

Both brokers said they wish Congress could work to make the new system better by addressing the law’s oversights and shortcomings. One big glitch, they said, affects people who have coverage through their job but cannot get decent coverage for dependents; the law does not allow people in this predicament to get federal subsidies through the websites to cover their dependents.

Penny Simonson

Although Penny Simonson and her husband, Pancho, purchase individual coverage now, they try to avoid medical care due to the steep costs and the limitations of their plan. “Unless the bone has protruded through the skin and we can’t stop the bleeding we don’t go to the doctor,” Simonson said. At 61, Simonson said she’s looking for a more affordable coverage option. She works part time, and her husband is getting close to Medicare eligibility.

After consulting with Denenny and Gulden, Simonson zeroed in on a new policy costing $1,674 a month. A $1,371 federal subsidy, based on her income, would cut her actual premium to $303. “Which makes me very happy,” she said.

Simonson’s current predicament, with a policy that offers little coverage, is a common problem, Denenny said. Complaints that the cost of insurance will rise substantially under the new federal law are often because current individual policies have such limited coverage.

The federal law requires future policies to cover considerably more.

But Denenny said insurance companies are worried that only people with health problems will sign up for coverage. If that’s the case, carriers’ costs will be high and they’ll be lucky just to break even, he said, let alone make a profit in 2014, the first year the federal law takes full effect.

The trick is persuading younger, healthy people that coverage is in their best interest.

“I work on the Mount Spokane ski patrol, and I’ve helicoptered young people out,” Denenny said. “I tell them, if you break your femur, you’ll have a $45,000 bill by the time you’re done.”

There is a misconception, Gulden said, that in the new system people can just sign up for insurance when they discover they need it. Not so: Every year, insurance only can be bought during the enrollment window, which is open now and closes in March.

But for 2015 insurance, the window will run only from October to December, she said.