Over the next few weeks, more than 20 staff members at Mosaic Medical will spend roughly 14 hours learning to enroll people in health insurance through the federal exchange, HealthCare.gov.

It’s a longer training process than that of Cover Oregon, which many Mosaic staffers underwent just last year. But because Cover Oregon decided to abandon its failed enrollment portal, Oregonians who choose to purchase exchange policies for 2015 will need to do so using the federal technology.

“There is tons of new training our staff needs to do to help folks,” said Elaine Knobbs, Mosaic’s director of programs and development.

Open enrollment for health insurance — the monthlong window in which people can enroll in policies — begins Nov. 15 this year, and ends Dec. 15 in order for policies to take effect Jan. 1, 2015. It’s a much shorter window than last year’s open enrollment, which ran from Oct. 1, 2013 to March 31 so that people had extra time to enroll during Cover Oregon’s first — and, it turns out, probably last — year.

If you’ve got that down, you’re ahead of most people. A poll released last week found that nine out of 10 people did not know when open enrollment begins, according to the Kaiser Family Foundation.

That could be a problem. The more than 100,000 people who enrolled in private medical plans through Cover Oregon must re-enroll into new plans during open enrollment or become uninsured in 2015. As for people who skipped the exchange and purchased directly from carriers, their policies will automatically extend into 2015 if they don’t do anything. Oregonians can choose to buy policies either through HealthCare.gov or directly from insurers, but low-income individuals can only get tax subsidies on policies purchased through the federal exchange.

Patrick Allen, director of Oregon’s Department of Consumer and Business Services, said he doesn’t recommend people simply let their plans roll over without doing some research.

Policies are changing in 2015, some by quite a bit, he said. Even if the premium didn’t change much, the deductible, co-pays and co-insurance rates could have fluctuated significantly. Not only that, policies’ provider networks — the providers you’ll have access to if you buy those plans — change frequently as well, Allen said.

Premiums alone will be between 20.6 percent less per month (Atrio Health Plans) and 10.6 percent more (Moda Health).

“It’s really important to go in and actually re-shop for insurance to make sure that you’re getting the best policy that meets your needs the best,” Allen said.

Enrollment confusion

One of the big questions looming in the heads of enrollment helpers like Mosaic is how much guidance they’ll be expected to provide people who ask for help using HealthCare.gov.

Under federal rules, nonprofit organizations like Mosaic — which locally include Healthy Beginnings, Volunteers in Medicine and Lynch Community Clinic in Redmond, among others — will be responsible for not only teaching people how to use the federal exchange, but also for helping them choose the best plan as well, Knobbs said. That wasn’t the case with Cover Oregon, which required people to go to insurance agents, not community organizations, for help getting to the nitty gritty about what policies actually cover.

That’s something Mosaic is nervous about, and is working to get a final answer on.

“We’re not insurance brokers,” Knobbs said. “We’re trying to figure out how much we have to help people in choosing their insurance when it’s private insurance, because we have always said that that’s not our business.”

Provider network, drug benefits

Two important things to keep in mind when choosing policies: provider network and prescription drug benefits.

People can (and should) go onto an insurance company’s website and see which doctors are included in their networks — meaning if you buy that policy, care from that provider is covered partially or completely — but that list does not necessarily mean you’ll actually get to see that doctor, Allen said. That’s because insurance companies make and break contracts with providers all the time, he said.

“So you may go and look at a website from an insurance company and find a particular physician that’s there, but by the time your policy begins, that may have changed,” Allen said.

The Oregon Insurance Division, a division within the Department of Consumer and Business Services, is currently drafting legislation for the 2015 legislative session that would ensure insurance carriers have adequate provider networks, Allen said.

In addition, Allen said it’s important to gain a good understanding of which drugs the policy covers at what level. That’s not always easy to determine just from reading a company’s website. Many less expensive, lower-coverage plans offer no savings for prescription drugs until enrollees have paid their deductibles, which can surpass $6,000.

Even more expensive plans that cover generic drugs may force enrollees to pay 40 to 50 percent for brand-name and specialty medications. Allen said the trend toward insurers pushing their clients toward generic drugs has been going on for decades. Allen’s department is currently working with a number of organizations, including Georgetown University, to study the impact of making people pay lots of money out-of-pocket for certain drugs.

People whose policies do not offer much prescription drug coverage can enroll in the Oregon Prescription Drug Program, a free program that can save members up to 50 percent on generic medications. The program, which is open to anyone regardless of income or insurance status, negotiates substantial savings by purchasing directly from insurance companies.

Bend resident Kevin Michael Jordan, 56, is currently covered under a Moda policy, but he thinks the small prescription drug benefit it offers is unfair compared with the amount of premiums he pays. The last time he bought medications, his insurance only covered about $6 of a $47 bill.

“It’s almost like, ‘Why even have it?’” he said, “You’re paying all these premiums every month and what they cover based on what your costs are — it’s kind of a drop in the bucket.”

The Oregon Insurance Division has followed through on 837 complaints regarding people’s individual health insurance policies this year, said division spokeswoman Lisa Morawski. In some cases, people said they didn’t expect to pay such a high cost for care. People also disputed claim denials and argued they thought providers were in-network when the insurance company considered them out-of-network.

That means you, too, OHP

Those enrolled in private plans aren’t the only ones who will need to take action to keep their insurance in 2015. Thousands of people who enrolled in the Oregon Health Plan, the state’s version of Medicaid, will also need to re-apply for the program before the end of the year to continue coverage.

Many new OHP enrollees came into the program through the so-called Fast Track program, which sent eligibility notices to people already receiving food assistance or other public assistance and allowed them to easily enroll in OHP by filling out a small postcard. The federal government provided Oregon a waiver, which allowed Fast Track to happen.

Now, however, many of those who enrolled that way must fill out a full application to verify their eligibility, which is several pages long and can take up to an hour, said Knobbs, of Mosaic.

A larger category of people who enrolled this year as part of the state’s Medicaid expansion will also need to renew their memberships in the program, but the application process won’t be as extensive as it will be for those who enrolled through Fast Track, said Kate Wells, director of community health development for PacificSource Community Solutions, the company that administers OHP for the coordinated care organization that covers Central Oregon and part of Klamath County.

Mosaic is reaching out to its patients who need to re-enroll to see if they need help, Knobbs said. More than 18,600 Mosaic patients are covered under OHP — about 52 percent of the provider’s total patient population — but it’s unclear yet how many of those will need to re-enroll, she said.

PacificSource is also ramping up its outreach in this area. Roughly 16,500 people in Central Oregon’s CCO will need to re-enroll by the end of the year or lose their coverage, Wells said. That’s out of about 295,000 people statewide, she said.

— Reporter: 541-383-0304tbannow@bendbulletin.com