For more than a decade now, we’ve been helping our clients complete individual health insurance applications. Before online applications were common, we would drive to our clients’ homes and help them fill out paper applications. These days, Jay spends many hours each week on the phone with clients who have questions at some point during the online application. On average, we’d say it takes most of our clients about half an hour to complete an online individual health insurance application. This is roughly the same as it took back in the paper application days, but online applications get processed much faster and are a great way to guarantee that no questions or signatures have been accidentally skipped.
Today, I spent some time reading through the 60 page draft of the proposed questions that applicants will answer in order to apply for health insurance in the marketplaces/exchanges starting this fall. At first glance (60 pages?!!) the questionnaire seems overwhelming. But it will probably end up being much more user-friendly than it seems now. The first page notes that the 60 page document contains all possible questions that could be asked of any applicant – many of those questions will be skipped for a lot of applicants, depending on their answers as they go along.
The draft explains that they expect most consumers to have to answer about a third of the total questions. It should also be noted that a large chunk of the questions apply to APTC (Advance Premium Tax Credit) and Medicaid eligibility. For applicants who answer “no” to the question about whether they would like premium assistance (for example, people who know that their income will be above the 400% of FPL eligibility range and don’t want to waste time on the application), the enrollment questions skip at that point from page 8 to page 49. There are questions to determine Medicaid and CHIP eligibility, and there’s even a question asking applicants if they would like to register to vote – if they check yes, they will be taken to their state’s voter registration form. So effort has definitely been made to make the application interoperable with other public systems and information as much as possible, including cross-referencing with IRS and SSA data.
The current health questions section that is on individual health insurance applications will disappear in 2014 – the only part that will remain is a question about tobacco use. The removal of the health questions will shorten the time it takes to complete an application, but after reading through the draft of the proposed new application questions, I think that the APTC eligibility and other financial questions (like Medicaid/CHIP) will more than offset the time saved by no longer having to complete the medical history questions. And although it’s obvious that a lot of work has gone into making the application/eligibility questions as straightforward as possible, the whole individual health insurance situation under the ACA is far from simple. You can get a plan inside or outside of the marketplace/exchange, but you can only get premium tax credits in the marketplace/exchange. Premium tax credits are based on income, and phase out at 400% of FPL. Coverage is guaranteed issue, but applicants will have to pay attention to open enrollment windows. There’s a lot that’s changing, and although a 60 page draft of application questions seems ridiculous at first, there’s probably not a way to cover all of the aspects of the new individual health insurance enrollment and APTC eligibility without covering all or most of those questions.
One concern that does occur to me when I read through the APTC eligibility questions is that some applicants might be unsure of how to answer, especially if they’re used to paying a tax preparer to file their tax returns (more than half of all returns are filed by a paid preparer each year). Just among my own friends, I know of several people who simply drop off their receipts, W2s and other tax documents at their local accountant’s office and wait to see their refund show up in their bank account. This is not uncommon at all – people are busy and taxes are complicated. But now that tax credits are going to be applied to individual health insurance premiums for a lot of people, income and tax issues are going to have to be addressed by most people (and the navigators and brokers who help them) who are applying for individual health insurance.