On Last Day to Buy 2016 Coverage via Marketplace, Enrollment Push Underway

Andrew Kitchenman | December 15, 2015 | Health Care
Pressure is on to sign up more NJ residents than last year, which would help keep prices for insurance premiums from spiking in future

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Today is the deadline for New Jersey residents to buy 2016 health coverage through the federal insurance marketplace — and avoid paying a tax penalty.

And it will require a last-minute push to avoid having fewer people insured through the marketplace than last year.

As of December 5, 80,152 New Jerseyans had either bought or renewed their insurance using healthcare.gov. That’s 25,154 fewer people than had signed up by last year’s December 15 deadline to have insurance.

The total number of annual enrollees is important because it can affect the price of future premiums. It works like this: Sicker people are more likely to sign up for insurance, but if there aren’t enough younger and healthier people enrolling, premiums must rise to cover higher costs. This can start a cycle of premium increases and enrollment decreases.

“We want a lot of young people” to enroll, said Raymond J. Castro, senior policy analyst for the liberal-leaning think tank New Jersey Policy Perspective. “For a healthy market, we’re going to need more participation,” he added.

It is possible that enough state residents have bought insurance over the past 10 days to exceed last year’s total. Insurance companies have been aggressively advertising their products, and the federal site has been overhauled to make it friendlier to consumers. The site’s
calculator for out-of-pocket costs has been refined, as have the search function for finding doctors and healthcare facilities in different plans, and the search function for prescription coverage.

But Castro is concerned that there hasn’t been more progress in enrolling residents during the first six weeks of the open enrollment period, noting that it would be a challenge to eclipse last year’s total.

He added that even if 25,000 people signed up over the past 10 days, “we would be where we were last year. But of course, we want to be above that … We’ll see what the final data shows, but I would like to see more people participating.”

The Affordable Care Act sought to avoid this problem by including an individual mandate. Those who aren’t insured must pay a penalty that’s equal to $695 or 2.5 percent of household income, whichever is higher. However, many people have chosen to pay the penalty rather than pay a higher price to buy insurance.

Insurers have been advertising new plans and taking other steps to bolster enrollment.

For example, Horizon Blue Cross Blue Shield of New Jersey has extended phone hours for its “Insure-A-Thon” call center. Horizon sales agents will be available until midnight tonight. The company also is operating a retail center in Moorestown from 9 a.m. to 8 p.m., as well as mall locations at Woodbridge Center, Newport Center Mall in Jersey City, Willowbrook Mall in Wayne, and Cherry Hill Mall — as well as a bilingual center in Jersey City.

Other factors will also contribute to increasing the final total. Most importantly, the marketplace will automatically renew those who didn’t make any changes to their plans. There will likely be tens of thousands of people enrolled in that manner. But those who don’t shop around or switch plans can face significant increases in their monthly premiums.

Horizon’s newest insurance product — the OMNIA tiered health plan — was intended to attract people who were concerned about the cost of insurance. While Horizon officials have said that the plan has drawn consumer interest, elected officials and others have criticized OMNIA. They’ve been concerned over what they see as a lack of transparency in how hospitals were selected for OMNIA’s top tier. Patients who visit top-tier hospitals pay less out of pocket than they would if they were to visit other hospitals.

Castro said he’s concerned that the OMNIA criticism is affecting consumers’ impression of their options on the marketplace.

“Hopefully that’s not affecting people, but you don’t really know,” Castro said, adding that he doesn’t think last-minute calls to delay OMNIA’s rollout have been helpful. He added that he agrees that there should be more transparency in state regulations for tiered insurance plans.

“All those things are good,” Castro said of proposed bills to improve transparency. “But I get concerned when” legislators call for changes that would force those who already enrolled in OMNIA plans to look for new plans.

Even if residents don’t enroll today, they will still be able to buy insurance that will go into effect later in 2016 through the end of the open enrollment period on January 31.