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Health care marketplace may not be open Oct. 1


– Details are slowly emerging about Indiana’s upcoming health insurance marketplace, including doubt that it will start enrolling residents Oct. 1.

The system might not be ready in 10 days, said Ryan Stoneburner, president and owner of Health Insurance Inc. The local firm helps business clients with human resources issues.

“The overwhelming scope of what we’re doing … has shocked me,” he said.

Stoneburner recently passed three online exams to become certified by the U.S. Centers for Medicare & Medicaid Services to help individuals buy health insurance inside and outside the marketplace. He also attended an insurance broker information session Wednesday hosted by Anthem Blue Cross Blue Shield.

Significant information he learned includes:

•Four insurers will offer policies in the region: Anthem, Physicians Health Plan, MDwise and Coordinated Care. Fort Wayne-based PHP will offer plans in the northern half of Indiana only. And Coordinated Care is selling coverage only in this corner of the state, Stoneburner said.

“Northeast Indiana is going to have the most competitive marketplace in the state,” he said.

•Anthem’s plans will include Parkview Health hospitals but not those run by Lutheran Health Network.

Health care providers are willing to accept in-network provider on a plan. The theory is that the additional patients more than offset lower payments for procedures.

“They got the best deal with Parkview,” Stoneburner said. “They’re trying to keep premiums – the costs – down.”

•Low-income individuals who qualify will be able to choose a basic policy that charges premiums low enough to be fully covered by a federal subsidy.

About a dozen Anthem officials spoke to brokers during the 2 1/2 -hour, nonstop session, Stoneburner said.

“We started out and they said, ‘You’re going to take a drink out of a water fountain (of information). But the water fountain is hooked up to a fire hose,’ ” he recalled. “It was crazy.”

Anthem is a major player in the state. The Indianapolis-based insurance company issued 60 percent of Indiana’s health policies in 2007, prompting concerns in 2009 from a coalition of advocacy groups that the state didn’t have enough competition.

Even so, the coverage Anthem will offer is only a portion of what will be available inside and outside the marketplace.

PHP didn’t return a message requesting information about its offerings. And Parkview spokesman Eric Clabaugh was unable to reach people within the network who are knowledgeable about insurance.

Geoff Thomas, Lutheran’s spokesman, said officials are dealing with daily changes.

“As part of the ongoing education that will take place, we will help individuals better understand all the options and where they can go for more information,” he said in an email. “We are looking forward to members of our community having expanded access to insurance coverage.”

Premium prices weren’t discussed Wednesday, but they will vary based on several factors, including age, region and whether a person smokes.

Broker’s advice

Stoneburner is certified to help consumers navigate the marketplace – something people should use only if their income is 400 percent or less of the poverty line and qualify for a federal subsidy.

Everyone else, he said, should shop for plans outside the marketplace, because insurers are being more creative with those plans, offering more options.

More than half of the U.S. population – 55 percent – had health insurance coverage in 2011 through their employer or another person’s employer, according to the Census Bureau. More than 840,000 people in Indiana are uninsured.

The uninsured are required to buy coverage or face potential federal penalties under the Affordable Care Act.

Although the marketplace is scheduled to go active Oct. 1, an Anthem official told Stoneburner and his peers that an email just received from federal officials said it might not be ready.

Insurance coverage bought on the marketplace won’t kick in until Jan. 1 at the earliest, so delaying the rollout by a few days isn’t a big deal, Stoneburner said.

The only downside is that consumers will have fewer days to make a decision.

Stoneburner won’t charge people to help them choose a policy. Brokers who help clients choose between policies earn commission from the insurance companies, he said.

Anthem pays the same amount regardless of how expensive the policy is, eliminating any temptation for a broker to steer a client to more expensive coverage within the same insurer’s offerings.

But different insurance companies might pay different commission amounts. Stoneburner said professional ethics prevent a broker from steering a customer toward the insurer that pays the highest commission.

Whether it’s his help or someone else’s, Stoneburner thinks professional guidance is crucial for most people, who otherwise might be apt to consider only the cost of premiums and co-pays when comparing plans.

“I think it’s going to be extremely challenging to do it on their own to get what they think they are getting,” he said.

Nonprofits helping

Some local nonprofits are also gearing up to help consumers. Neighborhood Health Clinics, Community Action of Northeast Indiana and the Volunteer Center are among agencies that plan to provide free enrollment assistance.

But officials for all three said they have yet to receive web-based training and certification from the federal government.

“There is a backlog” of applications across the nation, said Mary Haupert, CEO of Neighborhood Health Clinics. “Everybody applied at the same time, and they are trying to process them at the federal level.”

CANI program supervisor Paige Wilkins said the agency hopes to get the green light for providing enrollment assistance by late October. She said CANI applied Sept. 3.

“We’re ready to go. We’re just waiting on training,” Wilkins said.

Jean Joley, executive director of the Volunteer Center, said the same thing: “We have 54 volunteers waiting for training,” Joley said.

Joley said the three agencies plan to offer a combination of appointment and walk-in enrollment assistance if they are approved as certified application counselors for the Affordable Care Act.

Neighborhood Health Clinics is awaiting certification even though it was awarded nearly $174,000 in August from the U.S. Department of Health and Human Services to assist people with enrolling in the federal health insurance program.