With HealthCare.gov better able to process applications, the focus now is making sure that consumer enrollment information sent to insurers is accurate so that coverage can be activated without a hitch Jan. 1 and advance payments to insurers based on tax credits can proceed.
About 365,000 individuals selected plans from the federal and state marketplaces by the end of November. November enrollment in Healthcare.gov was four times greater than October's rough start, said Gary Cohen, deputy administrator and director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare & Medicaid Services.
"From what we are seeing and hearing, December will be significantly better than November because a lot of the fixes came in at end of November," he said Thursday at the AHIP Exchange Conference in Washington, DC. A Dec. 23 deadline will likely spur more individuals to enroll to assure coverage Jan. 1.
The 834 transactions are top priority to validate that all the generated consumer information has been captured, accepted and received. "We're at about 90 percent accuracy rate, and we can do better," he said. "We're going back to make sure that all the 834s previous to the fixes are validated as well."
Insurers are also preparing to receive advance payment for premium tax credits (APTC) payments to which they are entitled. CMS will use a temporary payment process initially. Insurers will report an estimate of payments that are owed until the online system is in place. Issuers must first submit test data files by Dec. 20 with enrollment and payment information in preparation for sending actual data for payment purposes in January.
CMS has piloted a direct enrollment process that is available to any issuer. Insurers have existing policyholders who are satisfied with their plan but may want to know if they are eligible for subsidies through the exchange, and their insurer is their trusted partner. Cohen said reports are mixed about its use, and CMS is working with plans to simplify the process for direct enrollment.
"From a legal standpoint, we can't delegate those functions," he said. The agency has to verify applicants' federal data, including Social Security number and legal presence in the U.S., to purchase plans and receive eligibility for subsidies.
Despite the early failed performance of Healthcare.gov, the ensuing uproar served a purpose, Cohen said, in his opinion. Going into October, the chief concern was that only a small percentage of people knew about the Affordable Care Act and the exchanges.
"Even though the publicity we got in October and November was not good, I venture to say that there is not a living, breathing American who hasn't now heard about what the ACA, Healthcare.gov, and the marketplaces are," he said.
Now CMS is trying to reach out through phone calls and emails to those who tried to create an account, determine their eligibility and to enroll "to please come back in. Give us another chance," Cohen said.
While CMS and insurers have collaborated extensively to roll out the exchanges and make coverage affordable for consumers, AHIP CEO Karen Ignagni said that more attention was needed to the prices that payers are charged by providers because that affects how they develop benefit packages, formularies and provider networks.
"There is more focus now, and we welcome it, on the unwillingness of providers to reduce the charges and their prices that were being offered in the old market to adjust to the new market," she said, as health plans try to offer consumers a number of affordable benefit and network packages to meet their budgets.
"Now the discussion needs to be enlarged to make sure that our provider partners are willing to do that and collaborate toward the goal," Ignagni said.