What You Didn’t Know About Canceling Your Health Insurance Through Healthcare.gov

I recently moved into a new part-time position which then became a full-time position and thereupon provided benefits including health insurance. Up until that point Sheila and I had been being hit with fairly large insurance premiums every month, so I was quick to call the insurance provider and request cancellation.

I was surprised when they told me that I’d have to contact Healthcare.gov to cancel my policy. Annoying, but not the end of the world and my guess is it is an accountability measure to ensure that insurance companies don’t cancel policies of individuals without their consent.

I called Healthcare.gov (1-800-318-2596) and asked to cancel my plan effective the 19th of June. I was assured this would be done. Great! I figured I’d have a nice partial refund check sent to me in a few weeks time.

I did receive mail from the insurance company – but it wasn’t the check I had been expecting. Instead I received a bill for July’s premium.

I called Healthcare.gov back and was informed that there was a thirty-day period between when they received a cancellation and when they submitted it to the insurance company. I balked. Thirty days? This should happen (and technologically is feasible) instantaneously!

I pushed back a bit and when they stood firm I acquiesced on one condition – they provide me with documentation of the thirty-day period. At this point I was given a case worker and then I waited to hear anything. Eventually I did hear – they had rolled back my insurance cancellation date to June 30th. This meant I no longer owed the insurance company anything but also that I would not receive a refund.

Today I called in again and was told that there was a 14 day waiting period. That they were sorry I hadn’t been told this before I canceled.

I again request documentation for this new shorter period. They suggested there might be some on the website…I found it: Cancel your Marketplace plan.

I could have canceled 14 days before the actual date I wanted the cancellation to occur if I had known about this 14 day period. I’m sure this may have been tucked away in some long-winded legalese that I reviewed at some juncture or another. I’m not happy about it, but it is a real policy.

Screenshot of cancellation policy for Healthcare.gov
Here is a screenshot of the cancellation policy as found on Healthcare.gov

The reason I share all this is to hopefully help others avoid losing out on premium refunds or being billed after their desired cancellation date.

My Experience with Healthcare.gov

I’m a geek – so of course I wanted to test out the healthcare.gov site immediately after it launched – and failed. First I wasn’t able to connect to the site and eventually when I did connect to the site it would let me go through the profile process but once it attempted to verify my identity it would drop me into purgatory and leave me there – forever and ever and ever (literally, I could leave the site and come back days later and I’d still be stuck there).

Screenshot of Healthcare.gov upper front page.
Screenshot of Healthcare.gov upper front page.

I tried a couple times creating, deleting, recreating, on various days and over various months – no luck. Finally I decided to call the phone number and admit that I, an IT guy, couldn’t get the site to work for me. The phone was picked up fairly rapidly and I was led somewhat painfully through providing all the information I had already provided numerous times via the site. At the end I was given an application ID number which the representative informed me I should “enter on the site” and it would show my enrollment – but that sometimes it took up to 24 hours for the change to happen on the site.

I grimaced at the 24 hour statement. While I was on the phone I attempted to pull up the application and of course it didn’t work. I had a pretty good feeling that if it didn’t work then it wasn’t going to work in 24 hours – and I was correct. The next day it still couldn’t find my application ID and weeks and even a month or two later it still could not find the application ID.

People have been noting how few younger people have been signing up through healthcare.gov and I wonder – does the system, for whatever reason, have problems with younger individuals? I don’t mean that it is intentionally discriminatory, but that the data about older individuals is more readily available, organized differently, etc. For example, it may be that older individuals already are “known entities” to the system b/c they have utilized services like Medicare. Just a thought.

Today I tried again…I successfully walked through the process from start to finish. I still don’t like the site design (it is using funky and complex functionality to display the forms, which I found to be jerky in transitioning…) and the site still managed to leave me with a few “what do I do now?” moments…

But it is all done, I’ve signed up for the Keystone Health Plan East HMO Silver Proactive. Cost is less than $230/mo. (unless the premium changes, which I have heard happens…). This may be a decent jump for young folks in good health compared to pre-Obamacare, but for me it is a huge drop. Since I have pre-existing conditions Keystone would have charged me around $600-$700/mo. for health insurance…which was just impossible for me (and thus I have been without health insurance for over a year now).

Ohh, but the real reason I wanted to tell you about this is b/c something bad happens if you don’t have health insurance by the end of March…which I think most people know (I know a fine…and I think “open enrollment” closes which means you can’t get healthcare until the next “open enrollment” occurs – which might not be for a few months), but perhaps more important – if you want to have coverage as of April 1st you need to be enrolled in a plan by March 15th. If you are registered after March 15th, your insurance policy won’t “start” until May 1st!

Why the Healthcare.gov fiasco SHOULD teach us to Open Source Government Application Development.

We Spent How Much?!

According to The Daily Beast the United States Government has spent $118 million to build Healthcare.gov and another $56 million in fixing it…and based on the fact that the site isn’t expected to be fully patched for some time yet I wouldn’t be surprised if the total cost in “fixing” exceeds that of building the system in the first place.

Image courtesy of OpenClipart.org and Iwan Gabovitch
Image courtesy of OpenClipart.org and Iwan Gabovitch

I’m not going to take a position on the Affordable Care Act (ACA) – I try to avoid speaking publicly on controversial issues…but I would like to suggest a lesson we can learn from the ACA that I don’t think will be (very) controversial across party lines – that the Government should utilize open source in the development of applications as a standard rule.

Now, I’m not particularly interested in arguing that every government project should be open source – I’ll be happy if 95-99% of them are. I understand that some people rightly or wrongly believe that using open source in sensitive areas could cause security risks. I’ll let Kevin Clough and perhaps Richard Stallman[1] argue that point.[2] But for the vast majority of projects (Healthcare.gov for example) I can see no reason why the development should not be open source and believe there would be significant advantages to such a course of action.

Lets take a look at the specific ways in which open source development could have reduced or eliminated the issues involved in the Healthcare.gov launch:

Transparency

The government (not just one department, but its entirety – e.g. the white house and congress) and the public could much more readily have seen that issues were arising, deadlines were slipping, etc.  and made necessary adjustments.

It is a constant problem within organizations that individuals at higher levels make decisions without the proper knowledge base upon which to make such decisions. This can result in unrealistic timelines and even if the timelines are realistic, if unexpected issues arise and there is slippage, there is a temptation to “gloss over” the setbacks and “hope” that the timeline can still be met.

This oftentimes results in extreme pressure on those actually working on the application as they are pressured to produce more, quicker – which, especially in the case of programming – is unwise. The more you pressure programmers the more likely they are to make mistakes, to take shortcuts and the more hours you demand of them the less productive they will become and, again, the number of bugs will grow exponentially.

Bug Fixes

Open Source software is oftentimes very stable and secure because of the number of eyes looking over the code. Further, individuals who are amateurs can make small contributions that allow the programmers to development on system architecture and bigger issues instead of stomping out bugs and making aesthetic improvements.

It would make sense for the Government to take a similar approach to Microsoft, Google, and Yahoo! on this front – each offers cash rewards for the discovery of issues. This is a relatively inexpensive way to get folks to pour in their energies – and individuals receive (for them) a significant compensation (hundreds to thousands of dollars – depending on the issue discovered).

Load Testing

The failure to properly load test the Healthcare.gov site is shocking. An open source project still needs robust methods of load testing performed by the core team – but it also benefits from other individuals and organizations implementing the application and discovering bottlenecks.

An open source, distributed team, also could have easily simulated the significant load that the site experienced upon launch – exposing the load issues early enough for remediation.

Code Reuse

When a project is open source the code can be reused by others for all sorts of purposes. The code to this project would certainly have applications in other government projects as well as the private sector. Reuse of code can significantly streamline development timeframes and even if someone in an entirely uses a portion of code for an entirely different project in a different industry – they will oftentimes contribute their version of the function (with enhancements/bug fixes) back to the original project (resulting in better, more flexible, secure, and robust code).

Cost

I really am just spitballing here – but I have a hard time believing that the development of an open source system to perform the Healthcare.gov functions would have cost anywhere near the costs expended thus far upon this closed source system. I’d guess that $10 million could have completed the project in a more robust and timely manner via open source.

Lesson Learned?

Please, let us take a lesson from this fiasco. We want more affordable healthcare – we can start by not wasting millions developing an application as a closed system which lacks robustness and stability.

I know some areas of the Government are already working with open source (and that is great) – but this needs to be a greater emphasis. Perhaps (I don’t know) there should even be some legislation that makes the (required) standard for new applications be open source and any applications which are desired as closed source systems should require review by a panel to determine if there is actual, substantial reasons for developing in a closed source system.

[Apparently I’m not the only one to think OSS could have made a huge difference. See this article by Christina Farr over at VentureBeat. Not directly related, but still interesting is Dylan Tweney’s article “Healthcare.gov costs show that feds have literally no idea how to build a big web site” also on VentureBeat. Another article comes from NBC News staff writer Gil Aegerter and can be found here.]

[11/4: Good article from Matt Asay entitled, “Sorry, Open Source Isn’t the Panacea for Healthcare.gov” on ReadWrite.]

  1. [1]Though Stallman would argue for free software rather than open source, but I leave that semantics argument, however important it may be, aside for the time being to focus on an area in which a relatively minor change in procedure (moving to open source development) could make a significant change in cost and efficiency.
  2. [2]There are some excellent arguments on how and why open source technology can be more secure than closed source technology. Specifically, the additional security in closed source systems usually isn’t b/c the systems are actually more secure but a function of “security by obscurity” – in other words, security holes exist, no one knows about them (including those who wrote the software). But I digress…

Health Care / Insurance Options.

U.S. Health Insurance Status (Under 65)
U.S. Health Insurance Status (Under 65) (Photo credit: Wikipedia)

Introduction

January 31st  is my last day as a benefited employee with Cairn University, February 1st is my first day full-time for Calvary Community Church of Penndel. One of the biggest considerations this involves is the change in my health insurance. For the last several years I have been blessed with a generous health insurance plan from Cairn University, now moving to a small church – the challenges of health insurance rest on my shoulders. So how should I proceed? I figured I’d share what I’ve learned in my research process thus far.

Conversion Insurance?

Conclusion: Too Expensive.

One option, including in Pennsylvania, is to convert one’s existing group/employer insurance into individual insurance. I talked to Keystone Independence Blue Cross – my current insurer and was informed insurance would cost around $600/mo. to maintain via conversion. Yup, a little higher than I’d like to pay.

Spouse Insurance?

Conclusion: Too Expensive.

Charity works full-time and has medical benefits, so another popular option would be to hop on to her plan. While she receives great subsidized benefits through her employer, the employer doesn’t appear to offer any subsidies for spouses, so the cost for the insurance would be slightly under $600/mo.

Other Options?

Conclusion: Not Eligible.

Another option is to look for a brand new individual insurance provider. One popular guide in this area is ehealthinsurance. I’m presented with plans from Aetna, Independence Blue Cross, HealthAmericaOne, and UnitedHealthOne. Prices start at $49/mo. and range up to $262/mo. Not bad, but I wonder if my pre-existing conditions will cause rates to race through the roof.

Update: I did look into plans through ehealthinsurance and after a significant waiting period (a few weeks) received a polite notice from Independence Blue Cross that my application was denied “based on your medical history…” The notice did inform me that I was eligible for some guaranteed coverage plans (but looks like premiums would be around $500/mo.) and for the Pre-Existing Condition Insurance Plan but this program is a government program which has been suspended.

Some folks who have lower income may also qualify for other options such as the IBX Special Care program.

Health Cost Sharing?

My final option is health cost sharing – this isn’t strictly speaking health insurance. Rather it is a non-profit that coordinates cost sharing amongst its membership. There are three major providers in the United States – and all three are Christian organizations.

Medi-Share / Christian Care Ministry

This is probably the largest non-profit health care cost sharing program. It was founded in 2003 and currently has 49,500 members. The website is slick, as is their process which is fairly streamlined. Costs are relatively low at $166/mo. for a single individual.

(And yes, I do get $200 for each referral I send to Medi-Share…that is pretty cool)

Samaritan Ministries International

Currently has over 21,000 members and was founded in 1991. Pricing is $150/mo. for an individual. Seems to be fairly manual and old-school in its methods of cost distribution.

Christian Healthcare Ministries

This organization is the one I’ve heard the least about – but apparently Mike Huckabee likes them. They seem to have the most generous provisions regarding pre-existing conditions and their “Gold Level” for an individual is $150/mo.

ObamaCare?

I also realize that ObamaCare is soon coming onto the playing field. In October of this year (2013) we can expect exchanges to open and health insurance to become more widely available and affordable (in part due to government subsidies). It seems to me that whatever choice I make, it is likely that it will be dramatically affected by what happens in October 2013 and that I’ll need to shop again around that time.

Conclusion

I’m really attracted to the non-profit sharing model – I like the idea of helping others and I’m a fan of non-profit health insurance. While the sharing model isn’t health insurance, it is similar in some ways. I’m leaning towards using them, but am also going to do due diligence with one or two of the recommendations from eHealthInsurance as well. I’m particularly interested in an account with Independence Blue Cross, as I’d like to keep my access to their electronic health records interface, and I am familiar with their process.

General Health Insurance Bibliography

 Medical Cost Sharing Bibliography

 

In my research I used the following search terms among others: health coop, nonprofit health insurance, nonprofit healthcare, nonprofit health insurance cooperative, health insurance, healthcare cost sharing.