A change of plans

North Dakota health insurers are reaching out to subscribers to help them navigate changes coming under the federal Affordable Care Act.

North Dakotans could begin signing up Oct. 1 for health insurance through a new national exchange, but technical glitches with the website have kept people from getting information.

The three companies offering health plans through the exchange in North Dakota have stepped into the void by sending letters to subscribers and conducting their own informational campaigns. Strategies have included fair booths, hotlines, seminars, websites, contact with other health-related entities and training of agents to ensure that information gets to the people who will need to make decisions about their health plans in coming months.

“We have gotten several hundred calls the last two weeks,” said Ruth Krystopolski, president of Sanford Health Plan, Sioux Falls, S.D. The response came after the company sent letters explaining options and costs to subscribers in individual plans that will be discontinued under the Affordable Care Act.

“We are providing them with the options that Sanford has and how that impacts them personally, whether it’s an increase or decrease and it’s all over the board, depending on the age and the size of the family and their underlying medical conditions,” Krystopolski said of plan costs.

Medica has been identifying comparable policies for its subscribers who will need to move into new plans. It also gives subscribers the option of choosing different plans that still meet their needs but at lower premium rates, if premiums are a concern.

“Usually the premium is going up because they have richer benefits,” said Larry Bussey, director of corporate communications with Medica, Minneapolis. “It’s not 100 percent true, but in most cases, someone who is going to move into an ACA-compliant plan is going to have more benefits and they are going to potentially have lower out-of-pocket (costs) because there’s limits on out-of-pocket in ACA, and the risk pool is different.”

Blue Cross Blue Shield of North Dakota also has been communicating with subscribers to explain their options.

Some people might see a decrease in total premium, but others will see an increase, said Luther Stueland, director of health policy impact and exchange operations with BCBSND, Fargo. Generally, with that increase in premium comes a greater level of coverage, he said.

Many people should be able to find a plan that stays in their existing premium range, although benefits could be different, he said.

Not everyone will be in need of new insurance. The health care law grandfathers plans that were in effect before March 23, 2010, and have not significantly reduced benefits since then.

When plans in the small employer and individual market lose their grandfathered status, they must be replaced by new plans that meet qualifications under the law. The law sets the bar for minimum level of coverage and requires 10 categories of essential benefits, such as mental health, prescription drugs and pediatric dental and vision care.

People covered through employer plans are not as directly affected, but employers will have to make decisions about future coverage if their plans are not grandfathered.

Coverage under most existing, non-grandfathered plans in the individual market will end on May 1, 2014.

People have the option of finding replacement coverage on the exchange or buying directly from the insurer. The three companies offering plans on the exchange in North Dakota offer the same plans and premiums both on and off the exchange. Federal premium subsidies are available only for plans purchased from the exchange, though.

People who enroll in a plan from the exchange before Dec. 15 will start their new policies Jan. 1, the date on which mandatory insurance coverage begins. People in non-grandfathered plans can delay until April 15 since they will remain covered through April 30 as long as their plans’ annual renewal dates don’t come up sooner. Signing up by April 15 would provide for the new insurance on May 1.

The government is granting special enrollment periods to people in non-grandfathered policies, although signing up after the 15th of a month could leave a gap because the insurance would not begin until the month after the next.

On May 1, BCBSND will automatically transition its members whose non-grandfathered plans have expired into similar plans outside the health insurance exchange if they haven’t signed up for replacement policies.

People who are uninsured on Jan. 1 would need to sign up with the exchange by Feb. 15 to get coverage by March 1 and avoid fines, Stueland said. Beginning Jan. 1, the law will mandate insurance coverage, and penalties kick in after a three-month gap in coverage.

Penalties in 2014 are $95 per adult and $47.50 per child, or $285 for a couple with two or three children. However, the penalty would be 1 percent of income that is in excess of the minimum tax filing threshold, if that amount is greater than the per-person rate. Penalties increase in 2015 and again in 2016, rising to $695 per adult, $347.50 per child, $2,085 for the typical family or 2.5 percent of income, whichever is greater.

Insurers have created online tools to help people determine their eligibility for subsidies and to find the best plan for their situations. People can find the tools or link to them from the companies’ websites.

“The idea was to make things simple, but it’s still a complex decision,” Bussey said. “The good news is there’s help available to people. They just have to take advantage of that.”