Glitches, Unknowns, Misprints & Delays

Day two of the Affordable Care Act's Open Enrollment period and we've continued to see issues with folks attempting to get traction in the form of finding an affordable plan and actually signing up.

While the biggest compliant we've heard from callers is that they simply can't get in, we have much bigger reservations as we dive into specific details in the plan offerings and also find issues with each insurer.

I'll highlight a few of the issues that are keeping us up at night and try to keep this short. From an "insider's" perspective these issues may be exciting and concerning, from a reader's view it might not be, so I'll try focus on the major issues and areas to watch.


The first item we've heard is that there is a system issue with the Treasury Department in determining the amount of a subsidy that a household qualifies for when more than one person is in a family. Effectively, the system only calculates the subsidy for one person, therefore leaving the other family members without assistance. This issue will give applicants a lower estimate of their subsidy, and if it is a real problem, will really make plans look more expensive for folks at the poverty level. Again, I haven't seen the issue, but am not amazed by this revelation if it is true.

No Access

We've heard that no one can get in to apply for coverage "on the exchange" so I'm going to guess this is a problem for Texans! I've seen a few news reports that suggest that hospitals are signing folks up, but using paper applications, (which will get lost and fouled up). County hospitals are really motivated to sign poor people up as this means they can convert non-payers into paying customers overnight.

Unknowns (They Don't Know, How Are You To Know?)

In our firm, we are deep in the weeds of plan design and we make every attempt to become experts on each offering that we use to achieve client goals. Many clients don't realize that the plan designs and details were not officially released until we all woke up on Tuesday morning! We attempted to call the sales areas of each of the major carriers to confirm our understanding of many of the plans we analyze and to our shock and horror we were told throughout the day that we understood their plans better than they did!


As we've torn apart the details of many of the plans we've found contradictory information about major facets of plan benefits. The contradictory data is pretty significant as two sources specifically state that services are / and are not covered. Other examples suggest that only a $200 co-pay for a delivery of a baby is due while the other source states that a $3,000 and co-insurance is due for the same procedure!

Blue Cross' major plan summaries online mislead in stating in many of their plans that a $10 co-pay or $30 co-pay will be charged but fail to highlight that a specialist will have a $50 or $55 co-pay. While this isn't catastrophic, it certainly isn't a picture of excellence and makes us question the validity of almost everything else that is produced in the plan summary.

Scary Stuff

We often get calls from agents in Texas that are looking for answers to very specific issues. We've always been in the habit of helping out other health agents because we want them to do well and we really want them to serve their clients. We had a scary call from an agent this week that was helping their clients leave the Texas High Risk Pool. The agent had not endured the training, certification, or verification process and was completely uninformed about what the exchanges were and how to proceed. I mention this story because there are professionals and not-so-professional business owners and employees in every industry.

The main issue I am concerned about though is that once you sign up for a plan, you are stuck with it for an entire year! Don't like it....too bad! Want to reduce your deductible....too bad! Don't like the HMO where you have to see a primary care physician to see a specialist....too bad! When you are buying a product you cannot get out of, you better understand what you are getting and you need to have insightful guidance from a professional. If you have any doubts about the knowledge and ability of your agent to follow through.... find another one! Call Texas Health Design at 713-422-2935 or visit our Contact Us page!

Complicated Stuff

Look, we live, eat, and breath this stuff. I'm typing this blog post this evening to take a break from rebuilding our plan summary and quoting platform. I am very certain that our team understands the plan design and process as well as anyone in Texas and maybe even the nation. I am also quite certain that the employees at the specific insurance companies and also the navigators with the government or even county hospitals know almost nothing about the plans and networks.

If the "professionals" on the 1-800 numbers don't know any details, how are shoppers to know a good buy or a bad plan or bad network? How will the purchaser of a Humana HMO plan know that he has ZERO benefits if he travels to Florida and stays there for a month? We were asked today by a friend if the prices that shoppers pay are any different if they buy from a carrier or buy from the Federal online exchange, or if they bought from Texas Health Design. The answer is simply NO! There is no difference in price yet we offer so much more!

Give It Time!

As we've written and stated all week, there is no rush to sign up for coverage. We are scheduling appointments with new clients and old friends. We confirm all appointments and we'll allow the government folks to work out their system issues and we'll design enhanced tools to allow us to compare plans and prices in a transparent way. Give us a call at 713-422-2935 or simply click here to visit our Contact Us page! When we hear from you we'll send you an email and gather a few pieces of information and set a time to meet and discuss your situation, your goals, and we'll find a plan that is great for your family.

Jason W Bohmann
Texas Health Design