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From Health Law Daily, November 19, 2013

Obama administration pushes “direct enrollment” as work-around for troubled HealthCare.gov sign-ups

By Paul Clark

In its continuing effort to help more individuals purchase health insurance, the Obama administration is now highlighting an option that has always been available but not talked about much—“direct enrollment” with health insurance providers. Using direct enrollment, an individual does not have to use HealthCare.gov or one of the state-based health insurance marketplaces, but can contact an insurance company directly to shop for a plan or check for eligibility for a subsidy to pay for insurance.

A CMS spokesperson on November 19 emphasized three routes for signing up for coverage—directly through HealthCare.gov or one of the state-based insurance marketplaces; direct enrollment with an insurance company; or in person through one of the hundreds of walk-in centers situated around the country. The spokesperson also said that CMS has entered into agreements with over 30 online insurance brokers to sign up individuals for health insurance. At a press briefing on November 18, White House press secretary Jay Carney also supported direct enrollment as an option for some people.

Background. 45 C.F.R. § 156.265(b)(2) provides that if an individual initiates enrollment directly with an insurance company, the insurer must either direct the individual to file an application with the marketplace (or Exchange) or ensure that the individual receives an eligibility determination for coverage through the marketplace web site. Guidance issued in April 2013 indicated that “CMS intends to make available a technical solution that allows a consumer to enroll through the Exchange using an issuer’s website or web-broker to initiate the enrollment process and complete plan comparison and selection.”

Other website functionality. The CMS spokesperson emphasized consumer functionality has had priority in terms of the fixes made since HealthCare.gov went live on October 1. Financial management functionality, used to process payments to health insurance companies, is still being worked on, and will not be completely functional until the middle of January 2014. This functionality is not necessary for individuals to pay for their insurance at HealthCare.gov; it only affects payments made to insurance companies.

80/20 figure. At a press briefing on November 18, Carney acknowledged press reports that up to 20 percent of people who try to try to access the federal health insurance marketplace, HealthCare.gov, will not be able to purchase insurance through the site. Carney said this 20 percent includes three main groups of people—those who continue to have difficulty accessing the site for technical reasons; those who either do not have access to a computer or who are uncomfortable sending personal information via a website; and “those who have a personal or family situation that is complex enough that the site is not the best place to go to enroll.”

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