Out-of-Pocket Calculator Included on HealthCare.gov for 2016

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Oct. 23 — The federal HealthCare.gov marketplace system that will be used in 38 states to enroll people in Affordable Care Act plans for 2016 will include an out-of-pocket cost calculator but won't initially have medical provider or prescription drug directories, Department of Health and Human Services officials said Oct. 23.

At a press briefing, HHS Health Insurance Marketplace Chief Executive Officer Kevin Counihan said that in the third ACA open enrollment season, which starts Nov. 1, HealthCare.gov will operate faster and more easily than in prior years and will include tools to help consumers choose plans based on total out-of-pocket costs. The Centers for Medicare & Medicaid Services issued a fact sheet listing improvements to the website for 2016.

About 9 million people are currently enrolled in ACA marketplace plans in all states and the District of Columbia, and HHS Secretary Sylvia Mathews Burwell has said about 10 million are expected to be enrolled at the end of 2016 (200 HCDR 200, 10/16/15). A preview of HealthCare.gov will be available Oct. 25.

Provider, Drug Tools to Come Later

Tools allowing people to determine whether their physicians are covered by plans as well as how plans cover particular drugs will be included when the CMS has enough accurate information, Counihan said. “We don't want to introduce anything that's not fully working,” he said. The CMS has the information currently on about 55 percent of the issuers selling plans on HealthCare.gov, which represent “a high percentage of the covered population,” and the agency is working in many cases with some of the smaller issuers, he said.

“We need to get more validated data” on providers and drug coverage, CMS Communications Director Lori Lodes said. “I expect that to be very soon.” Consumers will continue to be able to link to issuers' websites to see which providers are on their networks as they were able to do for the 2015 open enrollment, she said.

The new out-of-pocket cost estimator that will be available on HealthCare.gov when it opens Nov. 1 will enable shoppers to estimate their total annual health-care costs, including premiums and out-of-pocket costs such as deductibles, based on whether they are low, medium or high users of services, Lodes said.

Tax Credit, Medicaid Eligibility Information

HealthCare.gov has been tailored for specific individuals, providing more information about eligibility for Medicaid, premium tax credits that are available for low-to-moderate-income people under the ACA to help them pay for health insurance and cost-sharing assistance available for silver-tier plans, Counihan said. About 87 percent of people enrolled in coverage in the ACA marketplace qualify for financial assistance, he said.

Cost-sharing assistance for out-of-pocket costs is available under the ACA for people earning 100 percent to 250 percent of the federal poverty level if they choose silver-tier plans, which cover an average of 70 percent of medical claims. However, many people who are eligible for cost-sharing assistance choose bronze-tier plans, Counihan said. Bronze-tier plans cover an average of 60 percent of claims and usually carry lower premiums than silver-tier plans.

Re-Enrollment Simplified

People currently enrolled in ACA plans will be encouraged to shop on HealthCare.gov to determine if they have the best deal, as they were encouraged to do during last year's open enrollment, and re-enrollment has been simplified by allowing people to more easily compare their current plan with others, Counihan said. For the 2015 plan year, about 50 percent of enrollees went to the site to shop and about 25 percent of enrollees changed plans, Lodes said.

New screens also have been added to the website to remind people to submit correct documentation for eligibility, Counihan said. As of June 30 coverage had been stopped for approximately 423,000 consumers with 2015 coverage who failed to produce sufficient documentation on their citizenship or immigration status and advance premium tax credits or cost-sharing reductions had been adjusted for about 967,000 households, the CMS has said (174 HCDR, 9/9/15).

New processes have been put in place to identify problems and resolve them more quickly, Counihan said. That should help prevent the type of problems that occurred early this year when about 800,000 people received incorrect 1095-A tax forms needed to reconcile incomes with premium tax credits (35 HCDR, 2/23/15).

Advances Made Since First Open Enrollment

When HealthCare.gov and many of the state-run ACA marketplaces first opened in fall 2013 the websites were dysfunctional, preventing people from enrolling or causing long wait times. By the 2015 open enrollment period most of the problems had been fixed for consumers so that they could enroll more easily. The 2016 open enrollment lasts from Nov. 1 until Jan. 31, 2016.

“We've reached a new stage in the development of HealthCare.gov where we can advance the areas that we are working [on] and continue to improve this site based upon feedback from the consumers,” acting CMS Administrator Andy Slavitt said at the briefing. Response time on the website will be 40 percent faster than last year while, at the same time, customers will have more information, he said.

The HHS's primary goal is to reduce the number of people without health insurance, Slavitt said. For the third open enrollment, the agency is focusing on retaining current customers, increasing new enrollment and improving the consumer experience, he said. The HHS has estimated that about 17.6 million previously uninsured people gained coverage in the first two years of ACA enrollment.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com