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Clients Save, Insurers Get Boost From Affordable Care Act

Apr 08, 2014

This story was produced in partnership with 

There were plenty of nights during the last 33 years that Denise Schroeder of West Chester had to choose between eating dinner and paying for health insurance. And no, that is not an exaggeration.

Schroeder is a cancer survivor, and for many of those years, a working, single mom who felt lucky just to have coverage. Schroeder, who owns Happy Heart Clown 'N Stuff, a party entertainment firm, always fed her daughter but skipped meals herself when money was tight to ensure she could pay the $700 monthly premium.

With her savings account long since drained, her retirement fund exhausted, and an $880 monthly premium payment gobbling up almost half of her annual income, Schroeder, 62, could no longer make financial ends meet.

Then she heard about the Affordable Care Act. "I thought maybe this was my saving grace," Schroeder said.

Schroeder bought Independence Blue Cross' silver Keystone HMO. When the navigator said that her new premium payment was $22 a month - $858 less than she paid last month - Schroeder burst into tears.

"I have to know exactly what is covered and what isn't, and which doctors and specialists are on the list for this policy," she said. "It was nice paying the premium and then buying a few groceries."

Even as people continue enrolling to buy insurance plans through mid-April, Independence is focusing on the next phase: Helping people like Schroeder learn how to use their new ACA policies.

"We are fully aware that the process doesn't stop with the sale," said Paula Sunshine, IBC's vice president for consumer products. "We have a well-developed on-boarding program."

That program may have to expand since the company enormously underestimated its number of new enrollees. How enormously? Let's just say Independence might want to consider hiring statistician extraordinaire Nate Silver to make its next projection.

More than 110,000 people in the Philadelphia region and 68,000 consumers in New Jersey, through its AmeriHealth subsidiary, signed up for Independence plans, the insurer said. That was roughly 50 percent more than the company predicted and a five percent bump in overall membership.

"We've been blown away by the overall enrollment," said Dan Hilferty, Independence's president and CEO.

Those numbers are more impressive when compared with the reported 75,000 to 100,000 people enrolled nationally by insurance giant Cigna. And Independence's social-media efforts also seems to have paid off. The highly sought-after, young "invincibles" - 18-to-34-year-olds - were 27 percent of new enrollees. Customers 35 to 44 accounted for 15 percent, while those 45 and above totaled 21 percent.

"Now we have to service them," Hilferty said. "We're trying to be proactive."

The company is contacting new members via regular mail, e-mail, and phone to help them get up to speed, Sunshine said. New members will be asked if they have received an identification card, if they understand their plan's benefits, and, yes, if they have made their premium payment.

Sunshine said special attention will be given to people who bought Independence's best-selling silver HMO Keystone Proactive tier plan. New to the market, the plan has three tiers. Policy holders with a referral can use doctors and hospitals at any tier level. But deductibles, co-payments and coinsurances can vary dramatically.

To reach its Proactive enrollees, Independence is analyzing data on where people live so it can dispatch its Independence Express to hold neighborhood seminars. The goal is to make sure people understand the tier system - how one hospital could cost members three times more than another - and how the drug formulary works.

"We want to educate the public on how to use their benefits," Sunshine said. Members can call the company's customer service line at 888-879-4891.

Both Sunshine and Hilferty acknowledge that the company's call center has at times left people on hold for hours.

"We need to apologize," Sunshine said. "That is not the way we want to do business. We need to be better at it and we are putting every effort behind that."

Schroeder is excited about going to a meeting to learn more about her plan's benefits. "If it is in my area or close by, I will definitely go," she said. "Knowledge is power, and I'm going to utilize the system as much as I can."

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