Applying for Obama health care plan not easy

March 13, 2013 — WASHINGTON (AP) — Apply­ing for ben­e­fits under Pres­i­dent Barack Obama’s health care over­haul could be as daunt­ing as doing your taxes.

The government’s draft appli­ca­tion runs 15 pages for a three-person fam­ily. An out­line of the online ver­sion has 21 steps, some with addi­tional questions.

Seven months before the Oct. 1 start of enroll­ment sea­son for mil­lions of unin­sured Amer­i­cans, the idea that get­ting health insur­ance could be as easy as shop­ping online at Ama­zon or Trav­e­loc­ity is start­ing to look like wish­ful thinking.

At least three major fed­eral agen­cies, includ­ing the IRS, will scru­ti­nize your appli­ca­tion. Check­ing your iden­tity, income and cit­i­zen­ship is sup­posed to hap­pen in real time, if you apply online.

That’s just the first part of the process, which lets you know if you qual­ify for finan­cial help. The gov­ern­ment asks to see what you’re mak­ing because Obama’s Afford­able Care Act is means-tested, with lower-income peo­ple get­ting the most gen­er­ous help to pay premiums.

Once you’re fin­ished with the money part, actu­ally pick­ing a health plan will require addi­tional steps, plus a basic under­stand­ing of insur­ance jargon.

And it’s a man­date, not a sug­ges­tion. The law says vir­tu­ally all Amer­i­cans must carry health insur­ance start­ing next year, although most will just keep the cov­er­age they now have through their jobs, Medicare or Medicaid.

Some are con­cerned that a lot of unin­sured peo­ple will be over­whelmed and sim­ply give up.

“This lengthy draft appli­ca­tion will take a con­sid­er­able amount of time to fill out and will be dif­fi­cult for many peo­ple to be able to com­plete,” said Ron Pol­lack, exec­u­tive direc­tor of Fam­i­lies USA, an advo­cacy group sup­port­ing the health care law. “It does not get you to the selec­tion of a plan.”

“When you com­bine those two processes, it is enor­mously time con­sum­ing and com­plex,” added Pol­lack. He’s call­ing for the gov­ern­ment to sim­plify the form and, more impor­tant, for an army of coun­selors to help unin­sured peo­ple nav­i­gate the new sys­tem. It’s unclear who would pay for these navigators.

Drafts of the paper appli­ca­tion and a 60-page descrip­tion of the online ver­sion were qui­etly posted online by the Health and Human Ser­vices Depart­ment, seek­ing feed­back from indus­try and con­sumer groups. Those mate­ri­als, along with a recent HHS pre­sen­ta­tion to insur­ers, run counter to the vision of sim­plic­ity pro­moted by admin­is­tra­tion officials.

“We are not just sign­ing up for a dat­ing ser­vice here,” said Sam Karp, a vice pres­i­dent of the Cal­i­for­nia Health­Care Foun­da­tion, who nonethe­less gives the admin­is­tra­tion high marks for dis­till­ing it all into a work­able form. Karp was part of an inde­pen­dent group that sep­a­rately designed a model application.

The gov­ern­ment esti­mates its online appli­ca­tion will take a half hour to com­plete, on aver­age. If you need a break, or have to gather sup­port­ing doc­u­ments, you can save your work and come back later. The paper appli­ca­tion is esti­mated to take an aver­age of 45 minutes.

The new cov­er­age starts next Jan. 1. Unin­sured peo­ple will apply through new state-based mar­kets, also called exchanges.

Middle-class peo­ple will be eli­gi­ble for tax cred­its to help pay for pri­vate insur­ance plans, while low-income peo­ple will be steered to safety-net pro­grams like Medicaid.

Because of oppo­si­tion to the health care law in some states, the fed­eral gov­ern­ment will run the new insur­ance mar­kets in about half the states. And states that reject the law’s Med­ic­aid expan­sion will be left with large num­bers of poor peo­ple uninsured.

HHS esti­mates it will receive more than 4.3 mil­lion appli­ca­tions for finan­cial assis­tance in 2014, with online appli­ca­tions account­ing for about 80 per­cent of them. Because fam­i­lies can apply together, the gov­ern­ment esti­mates 16 mil­lion peo­ple will be served.

Here are some pros and cons on how the sys­tem is shap­ing up:

- Pro: If you apply online, you’re sup­posed to be able to get near-instantaneous ver­i­fi­ca­tion of your iden­tity, income, and cit­i­zen­ship or immi­gra­tion sta­tus. An online gov­ern­ment clear­ing­house called the Data Ser­vices Hub will ping Social Secu­rity for birth records, IRS for income data and Home­land Secu­rity for immi­gra­tion sta­tus. “That is a brand new thing in the world,” said Karp.

- Con: If your house­hold income has changed in the past year or so and you want help pay­ing your pre­mi­ums, be pre­pared to do some extra work. You’re apply­ing for help based on your expected income in 2014. But the lat­est tax return the IRS would have is for 2012. If you landed a better-paying job, got laid off, or your spouse went back to work, you’ll have to pro­vide added documentation.

- Pro: Even with all the com­plex­ity, the new sys­tem could still end up being sim­pler than what some peo­ple go through now to buy their own insur­ance. You won’t have to fill out a med­ical ques­tion­naire, although you do have to answer whether or not you have a dis­abil­ity. Even if you are dis­abled, you can still get cov­er­age for the same pre­mium a healthy per­son of your age would pay.

- Con: If any­one in your house­hold is offered health insur­ance on the job but does not take it, be pre­pared for some par­tic­u­larly head-scratching ques­tions. For exam­ple: “What’s the name of the low­est cost self-only health plan the employee listed above could enroll in at this job?”

HHS spokes­woman Erin Shields Britt said in a state­ment the appli­ca­tion is a work in progress, “being refined thanks to pub­lic input.”

It will “help peo­ple make apples-to-apples com­par­isons of costs and cov­er­age between health insur­ance plans and learn whether they can get a break in costs,” she added.

But what if you just want to buy health insur­ance in your state’s exchange, and you’re not inter­ested in get­ting any help from the government?

You’ll still have to fill out an appli­ca­tion, but it will be shorter.

Posted by Randa Wagner on Mar 13 2013. You can follow any responses to this entry through the RSS Feed. Both comments and pings are currently closed.