State insurance commissioner opens health care special enrollment

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YAKIMA, Wash. - After months of consumer complaints and delays from the Healthplanfinder website, state Insurance Commissioner Mike Kreidler has taken things into his own hands and opened a special enrollment period this week for customers who have had problems with billing and payment on the state health insurance marketplace.

The limited special enrollment session starts Wednesday and runs through Nov. 14, and is only for people who have had payment problems with their 2014 coverage to buy a plan for the remainder of this year, Kreidler said in a news release. It will allow customers to buy plans directly from insurance companies, rather than on the exchange.

Healthplanfinder launched last October with the implementation of the Affordable Care Act, and though it fared better than most exchanges nationwide, it hasn't been without bugs.

The biggest issue has been the poor communication between the exchange site and the private insurance companies offering plans. More than 5,000 customers statewide have reported problems with their insurance payments actually going through the system, which has led some people to assume they have health coverage when they don't, and some doctors to provide care for patients before realizing that those patients' coverage has not yet begun, due to missed payments.

Directors at Healthplanfinder said earlier this month that they've been working around the clock to fix the problems, but the insurance commissioner's office has gone ahead with its own solution.

Kreidler's office has the authority to open a special enrollment period after open enrollment has closed, and in fact, he received a letter from insurer Premera requesting he do so.

It's not a comprehensive fix. The main downfall of Kreidler's option is that in taking consumers out of the exchange, it also takes away the possibility of subsidies. So far, about 85 percent of people who have bought insurance on the exchange have received some level of subsidy on the coverage.

This option isn't permanent, either. Consumers who have been struggling for months with payment problems may find some relief in being able to buy a plan for the remainder of 2014, but they will still have to go through the normal open enrollment period from Nov. 15-Feb. 15 to purchase coverage for 2015.

Most, if not all, of the insurance providers available in Yakima County also offer plans off the exchange. Kreidler says consumers may stay with their current health insurer if they want, but may switch to a nonexchange plan.

Consumers may stay with their health insurer inside the exchange, but 'reset' their coverage (which would erase any credit toward the annual deductible and out-of-pocket maximum accrued over the past several months), or stay with their current insurer but switch to a nonexchange plan, or switch to a new insurer for a nonexchange plan, or switch to a different insurer or plan within the exchange.

Meanwhile, those who have experienced payment problems need to hold onto all their paperwork and stay in touch with Healthplanfinder staff about resolving their cases, insurance commissioner spokeswoman Stephanie Marquis said.

Kreidler said he does not want to take away from the efforts of Healthplanfinder staff, who are still working to reconcile payment issues for clients.

'It's just one more option for consumers who still need coverage,' he said in a release. 'It will not be the best option for everyone, but hopefully it'll bring immediate relief to some.'

More information and some frequently asked questions are on the insurance commissioner's website.