Here’s your guide to Obamacare 2.0, which starts Saturday

Saturday is the first day of open enrollment for 2015 health insurance offered through the Affordable Care Act’s marketplace. Timothy Johnson will be online bright and early, looking for a good deal.

Johnson, 24, dropped his non-ACA health plan a few months ago when the premiums doubled. The Kansas City college student, who works part time, couldn’t afford the higher rate. By going through the marketplace, he expects his modest income to qualify him for a premium subsidy and coverage he can afford.

“For me, health insurance is important,” Johnson said. “It’s a feeling of being secure. If I have to go to a hospital, I’m covered.”

ACA supporters are hoping there are millions more like Johnson who are eager to be insured. They also want enrollment to go more smoothly that it did the first time last fall, when attempts to sign up were often frustrated by the Department of Health and Human Services’ glitchy enrollment website, HealthCare.gov.

The department has kept its expectations low this time, with predictions that HealthCare.gov probably will still have some problems and enrollment will reach no more than 9.9 million, rather than the 13 million projected by the Congressional Budget Office.

But that isn’t deterring local nonprofit organizations from their efforts to enroll people. At least six enrollment events are scheduled Saturday in the metro area. And more than two dozen local organizations have trained staff ready to help people sign up for marketplace plans during the open enrollment period, which runs through Feb. 15.

They include safety net clinics such as the Samuel U. Rodgers Health Center and Swope Health Services, hospitals such as Truman Medical Center, the health departments of Johnson and Wyandotte counties, and a variety of community organizations such as El Centro and the Vietnamese American Community of Greater Kansas City.

Learning from missteps last year — canvassing neighbors doesn’t get many people insured, for example — the CoverKC enrollment campaign is focusing its efforts through organizations with strong community ties. The campaign’s sponsors include the Health Care Foundation of Greater Kansas City and the REACH Healthcare Foundation.

“We’re trying to be strategic about it. I think we’re in better shape than we were last year,” said Scott Lakin of the Mid-America Regional Council, which has been put in charge of coordinating the work of enrollment groups.

MARC also maintains the CoverKC.org website, which lists places offering enrollment help and has a calendar of enrollment events.

Referrals to enrollment organizations are being handled this year by the United Way of Greater Kansas City through its 2-1-1 telephone helpline, which gets about 125,000 calls per year.

“‘Do you have health insurance?’ will be a standard question we ask callers,” said Scott Jones, United Way vice president of community services.

Insurance agents, who earn commissions when they sell marketplace plans, also are making a push to sign up people. The Kansas City-based McDaniel Hazley Group, for example, opened an office last week in the 18th and Vine Jazz District and will reach out to the African-American and Hispanic communities, where ACA enrollments have been low.

The firm’s enrollment office will be open from 8 a.m. to 8 p.m. Monday through Saturday. It also has a call center with a bank of up to 25 phones. And it has partnered with 20 churches in Kansas City and Kansas City, Kan., that also will serve as enrollment centers.

“There’s a big need for education. People were just confused last year,” said Dana McGill-Brown, the firm’s vice president for operations.

Many people with low incomes didn’t realize they would qualify for premium subsidies, she said. Others assumed incorrectly that poor health would disqualify them.

Even among those who did enroll in ACA plans, not all were aware that many preventive services were available with no out-of-pocket costs, or that children’s vision and dental care were covered.

“People didn’t use their benefits,” McGill-Brown said.

But even people with some insurance savvy have been tripped up.

William Gray of Overland Park, who spent a decade in the insurance industry, was excited that the ACA plan he signed up for last year was going to cut his premium by about $800 per month. But he hadn’t anticipated one expensive technicality.

Gray is a cancer survivor and goes to the University of Kansas Hospital for periodic tests. While his plan covered the hospital, it wasn’t in the plan’s first tier of preferred hospitals, so it paid less of Gray’s bill.

“That’s my fault,” he said. “It just never dawned on me to look at Tier 1 and Tier 2. I didn’t even know there was a Tier 2.”

Instead of saving close to $10,000 this year, Gray’s savings are coming in at about half that amount.

“It’s extremely complicated. You have to drill down and look at all the plans,” said Nancy Metcalf, senior health editor of Consumer Reports magazine.

Metcalf suggests window shopping on HealthCare.gov before starting the enrollment process.

“The first mistake people make is to go for the cheapest plan,” she said.

These plans generally have high deductibles, which means they often won’t start covering your medical bills until you’ve already spent several thousand dollars out of pocket.

“That’s not good if you don’t have much money,” she said.

Check first to see whether the plans you’re considering cover the medications you need and the doctors and hospitals you prefer, Metcalf said, and, as in Gray’s case, whether the plans place hospitals in tiers. If you don’t take many medications and you don’t have an attachment to a particular doctor or hospital, you may be able to save money by selecting a cheaper plan that limits your choices, she said.

People already in an ACA health plan will automatically be re-enrolled, but they can switch plans. Metcalf recommends that people go online to HealthCare.gov to review their options.

If you expect your income to change next year, that could change your eligibility for a premium subsidy, and you need to update your information, she said. And changes in your plan’s premium or deductible, or in the list of doctors, hospitals and prescription medications covered, may make it worthwhile to move to another plan.

And here’s one more reason not to just let yourself be automatically re-enrolled for 2015: On Friday, independent analysts told The Associated Press that many people would see their premiums rise unless they switched to another plan.

“Just because you enrolled in a low-cost plan this year is no guarantee that your plan will also be low cost next year,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.

He analyzed a 48-city sample of 2015 premiums from data available earlier this week.

Caroline Pearson of Avalere Health, a private market analysis firm, came to a similar conclusion: “Last year’s low-cost plans will experience premium increases, meaning the majority of consumers will experience cost increases if they re-enroll in the same plan.”

There’s going to be a greater variety of plans being offered in the Kansas City area, which may be another good reason for more window shopping. Humana will have plans on the marketplace here for the first time, joining Blue Cross and Blue Shield of Kansas City and Coventry Health Care, which were the only insurers available last year.

After all the complications of his insurance plan, is Gray going to go back to the ACA marketplace again? Definitely not.

He just turned 65. He’s going on Medicare.

This story was originally published November 14, 2014 at 10:13 AM with the headline "Here’s your guide to Obamacare 2.0, which starts Saturday."