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Open enrollment: 4 facts insurers must know


The latest open enrollment period kicked off Sunday, one that the government expects to be one of the toughest yet.

Federal officals report that about 40,000 applications were submitted in the first six hours the marketplaces were open, according to the Washington Post. Day 1 was relatively quiet, an many exchanges opened without incident.

Now that Healthcare.gov is once again open for business, many Americans still have some questions surrounding their healthcare options. The federal government has set the modest goal of getting 10 million Americans insured through the exchanges by 2016, but it also is seeking retain more enrollees. Customers sometimes drop their ACA coverage because they are either unsure of their premium affordability or are befuddled by a particular health plan's requirements.

Whether it's making signups easier for customers, helping them choose a plan or understanding the upgrades and remaining issues on Healthcare.gov, here's what insurers need to know the three-month open enrollment period:

New price comparison tools

A recent upgrade to the Healthcare.gov portal, intended to streamline consumer searches for physician information and prescription drug costs, should be helpful for both existing and new exchange customers. However, as the government doesn't yet have enough information from insurers, that feature is "coming soon," a federal official has said.  

Still, customers will be able to benefit from an update that allows them to estimate their total out-of-pocket costs, including premiums, office visit co-pays and deductibles.

HHS recently released a report that said those who shop around for health coverage should save, on average, about $400 annually, but those savings aren't as high as advertised once average premium rate increases are factored in.

That said, it's imperative that insurers provide complete information about premium prices so that customers can get an accurate look at both what they can afford and what they can expect. 

The importance of consumer literacy

According to a previous report, 2.2 million Americans who qualify for health insurance subsidies don't access them. Taking the time to calculate out-of-pocket expenses before signing up for health care plans with low premiums could save customers money, as those earning incomes between 100 and 250 percent of the federal poverty line are eligible for subsidies.

The Congressional Budget Office estimates that 3 million Americans will miss out on federal money by signing up for a bronze plan in 2016. And even among those who have accessed subsidies in the past, many are at risk of losing them due to tax-return-filing issues.

Therefore, it is important for health insurers to provide all the facts surrounding out-of-pocket costs so that consumers have the most up-to-date information when comparing potential plans and know what financial assistance is available to them.

New privacy settings

Healthcare.gov is offering federal health insurance customers a new privacy management option in response to security concerns.  

By selecting a "Do Not Track" option, users are able to opt out of any embedded third-party analytical trackers, which would give private companies access to information such as age, ZIP code, smoking status, income or pregnancy status. While this information could be useful in terms of mapping out and locating people who need insurance, the collection of it has raised concerns from advocay groups.

Concerns over eligibilty issues

According to a recent report from the Government Accountability Office (GAO), eligibility decisions under the ACA are plagued with errors due to gaps in oversight and lack of coordination between some ACA exchanges. GAO determined that the "Centers for Medicare & Medicaid Services cannot identify erroneous expenditures due to incorrect eligibility determinations, which also limits its ability to ensure that state expenditures are appropriately matched with federal funds."

It's imperative that the government and insurers work together to ensure that expenditures are reported correctly and appropriately matched, GAO said in its recommendation. It was also suggested that the government establih a schedule for regular checks in order to prevent duplicate coverage or gaps in oversight.