People in Western Pennsylvania struggling to sign up for health coverage under the Affordable Care Act will have many more trained helpers to turn to this year — a significant change from a year ago when open enrollment began under the federal health care law.
More than 20 federally funded navigators and dozens of volunteer applications counselors are ready to offer assistance in Western Pennsylvania starting Saturday, the first day people can enroll in coverage for 2015 on HealthCare.gov, according to groups that received federal grants to provide guidance.
Those nonprofit groups and others said Friday that they also are planning more sign-up events across the region, along with more outreach to uninsured residents — all in an effort to boost enrollment in Pittsburgh during the second year of the biggest social reform since Medicare.
“We found that folks are more likely to complete the process with in-person assistance,” said Neil Deegan, Pennsylvania director of Enroll America, which is recruiting and training volunteers as certified application counselors across the state, including more than 20 in Pittsburgh.
A year ago when open enrollment started, there were no navigators hired or trained in Pittsburgh. The first person of about a half dozen navigators who eventually were working here wasn’t hired until two weeks after HealthCare.gov opened.
That slow start complicated the sign-up process, which was chaotic with an overwhelmed and malfunctioning website. Eventually, more than 28,000 people in Allegheny County enrolled through the website. More than 318,000 people statewide signed up.
The Obama administration promised Friday that the exchange website would work and signing up would be more efficient, thanks to a streamlined process, upgraded technology to handle a possible rush of buyers and an easier-to-use window shopping function that allows people to view their options before creating an account and enrolling in a plan.
“Whether consumers visit the simpler, faster and more intuitive HealthCare.gov or contact the call center, they’re going to find more choices and competitive prices,” said Health and Human Services Secretary Sylvia Burwell, who is traveling to Florida, Ohio, Texas and Virginia for enrollment events. The states, like Pennsylvania, use HealthCare.gov rather than establishing their own state-based exchanges.
Critics of the law warned consumers to watch out for changes in pricing and plans on the exchange.
Tax subsidies awarded to about 80 percent of enrollees last year won’t be recalculated if people let their plan renew automatically, which could mean higher-than-expected payments, according to the National Center for Public Policy Research, a conservative think tank in Washington.
And many health plans offered on the exchange are narrow network plans, meaning they exclude certain hospitals and doctors from coverage, which could cause a patient to pay costly out-of-network charges to see his or her preferred doctor, the center said.
“Last year the problems with the exchanges were readily apparent,” said David Hogberg, health policy analyst at the center. “This year the problems might be less apparent, but they are just as serious.”
Both of the center’s examples are issues in Western Pennsylvania, where competition for customers is causing some insurers to lower prices and where the two biggest carriers, UPMC and Highmark, offer only narrow networks. Health plans sold on the exchange in the region remain among the least expensive in the country.
UPMC cut its premiums significantly from last year. They are the cheapest in Allegheny County for plans that don’t include access to the Highmark-owned Allegheny Health Network hospitals.
Highmark raised its premiums that are only marginally more expensive than UPMC’s. Yet Highmark’s plans do not include in-network access to most UPMC hospitals and doctors in the Pittsburgh region.
With those changes, experts recommend that people who bought plans last year shop again.
“While automatic renewal could increase continuity of care for many consumers, many enrollees will be better off shopping and comparing again in 2015,” said Caroline Pearson, vice president at the consulting firm Avalere Health. “In particular, people who do not undergo a redetermination during the open enrollment period could end up paying more than they need to for insurance.”
Alex Nixon is a staff writer for Trib Total Media. Reach him at 412-320-7928.