Mainers Seeking Catastrophic Coverage Frustrated By Short ACA Enrollment Period

Dec 15, 2017

The deadline to enroll in the Affordable Care Act’s online marketplace is Friday, Dec. 15.

The Trump administration cut the sign-up period in half this year, and some consumers are feeling a time crunch — particularly those who want to buy catastrophic coverage, which requires a special exemption from the federal government that can take weeks to process. Some are still waiting as the enrollment period closes.

Jean Antonucci, who lives in western Maine, wants insurance coverage. She’s self-employed, so she needs to buy a plan in the individual market. She earns too much to qualify for subsidies, so her cheapest option would cost more than $800 a month.

“With a deductible of $5,400, is outrageous,” she says.

It’s also more than 8.5 percent of her income. That means Antonucci is eligible to buy cheaper, catastrophic coverage, which would cost her $622 a month.

“I don’t consider $622 a month an affordable thing, but I don’t want to be without insurance, and that is obviously $240 a month cheaper than the only other thing I can get,” she says.

Antonucci wants to buy that catastrophic plan, but first, she has to get approval from the Centers for Medicare and Medicaid Services, which administers the marketplace. And that’s where she’s run into problems.

She says she first applied in the beginning of November. Now, on the last day of open enrollment, she’s still waiting for an answer.

“The rules are set up, basically, so that you can’t win,” she says.

Other Maine consumers also face obstacles to buy catastrophic coverage, says Maine Bureau of Insurance Superintendent Eric Cioppa. They need a special exemption number from CMS, he says.

“[It] can be quite onerous and take a long time. We’ve been told as much as four weeks,” he says.

And Cioppa says it’s not something you can start by phone or email.

“Believe it or not, it’s our understanding that you have to do it by mail. And you have to get a response by mail, and that gives you a number that allows you to move forward,” he says.

It’s a problem that’s exacerbated by this year’s shorter enrollment period, says Steve Butterfield of Consumers for Affordable Health Care. It was cut in half to six weeks.

“If you don’t get your number until after open enrollment, it seems they’re not going to let you back through the door to purchase that catastrophic plan with that number after the fact,” he says.

Cioppa says it’s possible consumers could purchase a regular plan, then switch to a catastrophic plan once they receive their number, even after open enrollment ends. But he’s not sure.

“I wish I could tell you we nailed this down, but we’ve heard conflicting information from CMS,” he says.

Antonucci says she hasn’t been presented with that option. And she says she’s made several calls to CMS and the insurance co-op offering the catastrophic plan, Community Health Options, for help.

“The marketplace simply insists it takes up to 30 days to process this, Maine Community Health Options will not sell me this until they have a number — some kind of an exemption number from the marketplace,” she says.

CMS did not respond to a request for comment for this story. Antonucci says she’s trapped. She doesn’t want to go without health insurance, and thinks she’ll have to buy the plan that costs more than $800 a month.

“I’m out of my mind with frustration,” she says.

And she isn’t exactly a newcomer to the complex world of health insurance. In fact, she’s a primary care physician. She has a small, independent practice and says she has helped her patients get insurance on the marketplace.

“I’ve helped people get insurance for free, or practically nothing, but I can’t get insurance,” she says.

Not as a middle-income earner, she says. Not even through a special mechanism that’s supposed to help.

Mainers who were delayed in applying for health care coverage because of the recent windstorm that caused extended power outages will be eligible for a special enrollment period. That’s according to a statement issued late Friday afternoon by U.S. Sen. Angus King of Maine, who says he had requested that the Centers for Medicare and Medicaid Services make an exception for those Mainers.

In a response letter to King, CMS Administrator Seema Verma says she agrees that affected applicants should qualify for exceptional circumstances. Verma urges those applicants to call the marketplace call center at 1-800-318-2596 and talk with a representative.