Government reports out this week that Affordable Care Act enrollment applications may have contained four million inconsistencies come as no surprise to brokers and agents in the field who say individual enrollees were confused by the process and will likely turn out in droves for adviser help during the next open-enrollment period because of it.
Approximately 2.1 million people enrolled through the new health insurance exchanges were affected by one or more inconsistency, according to a May 8 federal document obtained by the Associated Press and confirmed this week by Julie Bataille, spokeswoman for the U.S. Centers for Medicare and Medicaid Services, the agency responsible for the health care laws rollout. Most of the data discrepancies involve details on income, citizenship and immigration status.
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Naama Pozniak, agent and owner of A+ Insurance Service in Studio City, Calif., says shes not surprised the applications contain discrepancies, as individuals were very confused, by the enrollment process, especially about reporting adjusted gross incomes which were supposed to be estimated for the year 2014 and not based on past income tax filings.
How can you truly estimate? Peoples incomes are flexible and can vary month to month, she says, noting this is especially true for individuals needing to enroll in the exchanges who are often self-employed or change jobs frequently. People who are employed in a consistent full-time position often obtain health care coverage through their employer.
The income calculation is challenging, agrees Chris McArdle, an agent at the Milwaukee, Wis.-based Rauser Agency, which enrolled hundreds of individuals in health care plans on the exchange during the first open-enrollment period.
But that was not the only challenge, he notes. More than half of the individuals the agency saw that began the enrollment process online at home had material errors that needed to be corrected with adviser help.
As a broker, Pozniak says, shes constantly e-mailing clients to make sure they understand reporting requirements, including updates to income, job status, citizenship, etc., that may impact their subsidy eligibility.
Outdated information
CMS Bataille noted that most of the four million inconsistencies found on ACA applications are actually due to outdated information.
"The fact that a consumer has an inconsistency on their application does not mean there is a problem on their enrollment," says Bataille. "Most of the time what that means is that there is more up-to-date information that they need to provide to us."
The "vast majority" of cases are being resolved in favor of consumers, she says, adding that the government is making an all-out effort to reach those with various discrepancies.
Under the health law, consumers typically are given 90 days in which to submit additional information to verify the information on their application. Most people who applied during open enrollment are still within that window, and, for those who arent, CMS is giving them extra time to provide documentation, a flexibility the ACA is providing for the start-up year of 2014, Bataille says.
However, if consumers dont provide sufficient proof to support the information they attested to, they will have their eligibility ended or changed to reflect what is recorded in trusted data sources, she adds.
Open enrollment boom
Consumer confusion with the enrollment process and application requirements is exacerbated, Pozniak says, when individuals are allowed to enroll online without any assistance from somebody who can answer their questions or clarify these confusions.
Following this flood of data inconsistencies and continued consumer confusion with the enrollment process, she expects advisers to experience a huge number of individuals seeking help during the 2015 plan year open enrollment, which runs Nov. 15, 2014 through Feb. 15, 2015, according to Healthcare.gov.
Pozniak says in the coming months, People will begin to realize they made mistakes, they chose the wrong plan, they need to go from the exchange to a private plan or their provider is not on the plan they chose, adding that they will want help avoiding those mistakes during the next open-enrollment period.
Its going to be huge, she says. Were already preparing for it.
McArdle says due to the experience and knowledge of the brokers at his agency, they were able to help many individuals purchase health care coverage at low-cost premiums they may otherwise not have been able to without the guidance of an adviser.
Because of that, he says, whether its advisers at his agency or elsewhere, he hopes more individuals will turn to advisers for help during the next open enrollment.
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