ADVERTISEMENT

The NY State of Health insurance exchange is on pace to meet the state’s enrollment goals, and the website is far outperforming the troubled HealthCare.gov federal exchange.

But this doesn’t mean everything is going smoothly for the hundreds of thousands of New Yorkers buying insurance there.

People who have tried to enroll through NY State of Health say they’ve frequently found the site out of service, regularly run into issues entering information into the site, spent hours on the phone to get help from someone and waited weeks to receive confirmation of coverage.

Many of the 134,622 who as of early last week had made it to the end – and the navigators hired to help them through the knotty enrollment process – describe their sense of relief with the kind of language that might someday greet a Buffalo Bills victory in the Super Bowl.

“I have crossed the River Styx and reached the Promised Land,” said Mary T. Stengel, a freelance writer and editor from West Seneca, summing up how she felt when her enrollment journey was finished and her coverage was confirmed.

Even as New York touts its successes with the exchange, some fundamental questions remained unanswered because the state Health Department has not released a detailed breakdown of enrollment data.

We don’t know who is signing up, where or with whom – making it unclear whether the enrollees include the young, healthy and previously uninsured who are critical to the financial health of the exchanges.

“That level of data, we don’t really have yet,” said Lisa Sbrana, counsel at the Health Department, citing a “fluid” situation with thousands of people attempting to enroll every day.

And the state’s decision to push back the deadline – from Dec. 14 to today – to sign up for coverage that kicks in Jan. 1 leaves the Health Department, the Internal Revenue Service and insurers scrambling to quickly and accurately share the data needed to enroll everyone who is buying coverage on the exchange.

December already is a jam-packed time of year for health insurance companies, with open enrollment for many of their regular clients, and it will only get busier with everyone trying to enroll by today’s deadline for coverage that takes effect with the new year.

“They’re all working very hard to make all of this happen the way it’s supposed to,” said Leslie S. Moran, senior vice president of the New York Health Plan Association, which represents managed care plans.

As of early last week, 95,196 New Yorkers had enrolled in a private health plan through the exchange, putting the state on pace to meet its goal of enrolling 615,000 individuals in private insurance by the end of 2016. An additional 39,426 were insured with Medicaid.

New York’s exchange website struggled to handle the volume of visitors immediately after its Oct. 1 launch, but state officials say the site has added computer server capacity and functioned well recently, considering the high level of activity.

“The website has been great, really, after those first three days,” Sbrana said.

The exchange has a phone help line, with users reporting long delays before getting to talk to a representative. The state has added extra staff to handle the call volume, which reached 1,500 people per hour Friday, Sbrana said.

And the NY State of Health Facebook page is filled with questions from frustrated exchange users and game attempts from page administrators to address their problems.

Some of the issues are technical, and others stem from the complexity involved in maneuvering through the exchange and picking through the various options to select a plan.

“People have been very patient,” said Christin M. LoFaso, director of the navigation program run out of Niagara Falls Memorial Medical Center.

LoFaso and other navigators were hired through the Affordable Care Act to help guide members of the public through the enrollment process. This can take an hour or more just to enter detailed personal and financial information.

For people who haven’t had health insurance, finally getting through to pick a plan and sign up for coverage can prompt an emotional reaction. “I had a woman last week say, ‘You’re my angel,’ ” LoFaso said.

Chautauqua Opportunities has two full-time navigators, along with Melanie Booth, its health insurance access coordinator, who assures people coming in for appointments that it’s the federal exchange that is having all of the well-publicized issues. “We’ve had very few problems,” Booth said.

Kaleida Health’s navigators have handled nearly 1,300 phone calls and have scheduled more than 250 appointments, even though technical difficulties prevented them from logging into the exchange portal until mid-October, said Simmone R. Washington, manager of Kaleida’s financial counseling services department. Their appointments are fully booked into the new year.

“The folks who have come to us are finding plans that are affordable and that are less expensive than they thought they’d be,” Washington said.

For many of the people trying to do this on their own, applying for health insurance has severely tested their patience.

Stengel, 59, had coverage with Univera Healthcare, through Healthy NY, for $269.75 per month; but the Healthy NY program expires this year. Last month, she went onto the exchange for the first time.

After five attempts over five days, she chose a BlueCross BlueShield of Western New York “silver” plan that costs $195 per month, plus $15 per month for added dental coverage.

She said it took another month for her to get an invoice confirming her enrollment. “I have never been so happy to get a bill for $195. Yippee, I’ve got a bill. I’ve got a plan,” she said.

Daniel R. Sack, a self-employed Elm- wood Village resident, needs coverage through the exchange until he turns 65 next summer and is eligible for Medicare. He pays $518 per month now for coverage with BlueCross BlueShield of Western New York.

Between time on the website and on the phone with the help line, he estimates he spent six frustrating hours on his quest to get exchange coverage.

He ended up with 53 plans to sort through and quipped that he may need an Ouija board to help him make up his mind, before picking a Health Republic plan that costs $366.60 per month. “I’m definitely happy that the ACA has opened up the market to companies like Health Republic,” Sack said. “Saving $150 a month is nice for anyone, especially the self-employed.”

The architects of health care reform are counting on young, healthy people who didn’t previously have health insurance – and who aren’t expected to be heavy users of health care services – to sign up through the exchanges and balance out the cost of insuring everyone else. An extensive marketing campaign – along with a system of subsidies and penalties – is meant to encourage them to enroll.

About 1.5 million New Yorkers, including 63,640 people in Erie County, will be eligible for some form of tax credit, which can take hundreds of dollars off the monthly insurance premium, according to a report released by Families USA.

The penalty starts in 2014 at $95, or 1 percent of household income, whichever is greater. It rises the next year to $325, or 2 percent, and in 2016 to $695, or 2.5 percent.

Tara L. Himes, a North Buffalo real estate agent, and Nicholas B. Guy, a freelance writer who lives in the Delaware District, lost their insurance when they turned 26 and were no longer eligible for coverage under their parents’ plans.

Himes now pays $150 per month for a policy with Excellus Health Plans, through Healthy NY, that has no drug coverage.

She learned she could buy comparable coverage directly through Excellus for $360 per month – too high for her budget.

Himes said her income can vary widely each month, and the exchange seems to have trouble accounting for this.

She still doesn’t know what she’s going to do next year. “It’s a little bit stressful to think about it. What if something happens and I don’t have coverage?” Himes said.

Guy hasn’t had insurance for about 15 months. He logged on to the exchange Oct. 1 but couldn’t get through to the section on his plan options until a few weeks had passed. “The plans were a little bit more than I expected,” said Guy, who isn’t eligible for a tax credit. He found prices ranging from $150 per month for Health Republic’s catastrophic coverage to $630 per month for Univera’s platinum plan. On Dec. 12, he selected the Health Republic plan with low premiums but high out-of-pocket costs.

“It’s more just in case anything catastrophic happens, I have a safety net,” Guy said.

There’s no information yet on whether other young, healthy “invincibles” are signing up for coverage on New York’s exchange.

NY State of Health is collecting demographic data on enrollees and expects to release detailed information next month, along with a breakdown of data by region, by company and by previous insurance status.

For the insurers, December is open-enrollment period for many of their business clients and Medicare Advantage members, and the companies already are busy processing those accounts.

A lot has to happen behind the scenes for the insurers to properly enroll their new exchange members, and to make sure any subsidy is accurately counted, a process that involves the IRS, as well as the state Health Department.

To be considered fully enrolled for insurance, members must pay the first month’s premium, and they have until Jan. 10 to do so for coverage retroactive to Jan. 1.

Anyone who misses today’s deadline isn’t completely out of luck. New Yorkers have until Jan. 15 to sign up for coverage that begins Feb. 1, and similar monthly deadlines are in effect until the end of 2014’s open-enrollment period March 31.

“We’re doing everything we can,” Sbrana said, “to get everybody up on Jan. 1.”

email: swatson@buffnews.com