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Maryland Plan Offers Retroactive Coverage Due To Sign-up Problems

Dr. Peter Beilenson may be the only health insurance CEO who picks up the phone when reporters call. So Kaiser Health News bothers him a lot. We caught up with the boss of Maryland’s Evergreen Health Co-op late last week to learn how one insurer moved from Obamacare theory to Obamacare practice.

“They have their first appointments,” he said of the plan’s clinics. “We’ve seen our first patients.”

But not nearly as many as the company had hoped for.

A consumer-owned cooperative started with federal loans, Evergreen runs four health centers in metro Baltimore and Greenbelt, near Washington, D.C. Since Oct. 1, the company has struggled with Maryland’s dysfunctional online insurance marketplace, Maryland Health Connection, which so far has enrolled 18,257 people in private health plans like the ones sold by Evergreen.

The online exchange has gotten “mildly better,” Beilenson said. But even after the New Year launch date of coverage under the health law Evergreen got “significant numbers of calls — in the dozens of people — who have tried to go on the exchange for between a week and 10 weeks and have been frozen out,” he said. “Now they’re calling us out of desperation”

Evergreen would try to enroll subscribers through the first week in January for coverage retroactive to Jan. 1, he said. After that, new enrollees will get care starting Feb. 1. Individuals can sign up through March 31, the end of open enrollment for 2014.

The Obama administration has asked insurers to be flexible in offering coverage to consumers with trouble signing up and paying on time. On Friday Maryland Gov. Martin O’Malley called for legislation that would expand a state-run plan for high-risk subscribers to include those who were unable to sign up on Maryland Health Connection.

Enrollment on Maryland Health Connection still isn’t easy, even with Evergreen’s staff trying to walk customers though the process of signing up for subsidized coverage.

On average, “we kind of jam through five or six a day — that’s how hard it is,” Beilenson said. He estimates more than 1,o00 people eligible for subsidies are waiting to sign up as Evergreen customers on individual or family policies. But fewer than 200 had bought individual plans as of Thursday.

The plan has higher hopes for gaining members though policies sponsored by employers. When it became clear in October that online signups for individuals would be a problem, Evergreen switched tactics.

“Clearly the majority of our enrollment is going to come initially from small business,” Beilenson said. So far the plan has signed or is close to signing more than 100 employers and expects to have “a couple thousand” members in business-sponsored plans by March.

Evergreen hopes eventually to gain 15,000 or 20,000 members. Like other co-ops financed under the Affordable Care Act, it needs to quickly gain subscribers and revenue to pay back government loans. But it doesn’t need to enroll them all the first year, Beilenson has said.