Facing premium hikes and limited choices, health insurance shoppers are rushing to make final decisions in advance of Thursday's deadline for individual market coverage.
More people are enrolling via the state's MNsure health insurance exchange than last year, possibly so they can tap federal tax credits that discount the out-of-pocket premium costs.
There are signs that individual market enrollment might be weaker than expected after factoring in sign-ups outside MNsure, but the focus this week has been on the deadline rush.
"It is quite a hectic time," said Maureen O'Connell, president of Health Access MN, a St. Paul group that employs navigators who help people enroll in coverage.
Thursday is the deadline for people to buy coverage that takes effect Jan. 1 in the individual market, which serves about 250,000 Minnesotans. It's the market for self-employed people and those who don't get coverage from their employer or a government program.
The individual market has undergone fundamental changes with the federal Affordable Care Act, including new health insurance exchange websites like MNsure that are an option for people who buy coverage on their own.
"We've seen a lot of good traffic," said Allison O'Toole, MNsure chief executive, at a board meeting on Wednesday in St. Paul. "We are more than double the number of [private plan enrollees]."
After Thursday, people still can sign up until Jan. 31, but the coverage won't take effect until later next year.
The tough shopping season for consumers could be driving down demand for policies that insurers sell directly to consumers.
"Enrollment in individual plans is slower than last year at this time and slower than we expected," said Catherine Scott, a spokeswoman for Bloomington-based HealthPartners, in an e-mail. "Premium increases may be a factor, and we encourage people to find out if they are eligible for tax credits."
Open enrollment started Nov. 1 with lengthy waits at the MNsure call center that DFL Gov. Mark Dayton blamed on "robocallers."
MNsure says its systems have worked smoothly since, but policies in the individual market are pricey and limited.
This summer, the state's individual market nearly collapsed when insurers told regulators that given financial losses, they were considering a mass exodus.
The turmoil occurred after an announcement from Eagan-based Blue Cross and Blue Shield of Minnesota that pulled policies which currently cover about 100,000 Minnesotans.
Blue Cross still sells HMO policies in the market, but the coverage — like those from other carriers — includes limited choices when it comes to doctors and hospitals. In the Twin Cities, for example, consumers in the individual market can't buy a policy that gives them in-network access to the Mayo Clinic in Rochester.
Regulators also approved rate increases of 50 percent or more for all carriers. And HealthPartners, Medica and UCare were granted enrollment caps. In November, Medica hit the cap, so its policies in the individual market are no longer available to new customers.
Although some insurance agents thought all insurers might hit their caps shortly after Nov. 1, it hasn't happened yet. It's unclear whether that's a sign of flagging demand for individual market policies.
Insurers and agents say there could be an increase in self-employed people moving from the individual market into health plans for small groups. Such moves are possible only in certain circumstances, but there are signs that more people are considering the switches.
"We believe we are seeing an uptick in requests for coverage for groups of three or fewer, but don't have data on hand to provide a comparison to previous years, said Greg Bury, a spokesman for Minnetonka-based Medica, in a statement. "There are requirements that specify what qualifies a company for group coverage."
Government-run health insurance exchanges across the country haven't grown as quickly as insurance companies had hoped. Slow growth and a lack of young and healthy enrollees have contributed to financial losses that have driven many carriers from the market.
So while MNsure's enrollment is far beyond last year's pace, that doesn't necessarily mean the overall individual market is growing. In previous years, most people have bought outside the exchange, so MNsure's gains might simply reflect a shift in where people are buying.
For weeks, Dayton and lawmakers have been sparring over the details of whether to call a special session of the Legislature that might provide rebates to some consumers in the individual market who are facing premium hikes.
Those deliberations are factoring into decisions about whether to stick with individual market plans or switch to small employer policies, said Bob Stein, president of the Minnesota Association of Health Underwriters, a trade group for insurance agents.
"It's crazy busy," said Stein, who is an insurance agent in Eagan with Employee Benefits Corp.
As of Monday, 41,882 people had signed up for private coverage through MNsure, O'Toole said. The tally as of Dec. 8 last year was 17,678.
The exchange will have extended hours Thursday, O'Toole said, with the MNsure call center open until midnight. If someone phones MNsure for help enrolling just before midnight, she said, operators will stay on the phone to complete the sign-up.
MNsure is the only place for Minnesotans to access federal tax credits provided by the federal government under the federal health law.
"This year, our tax credits have tripled compared to last year — the average is more than $600 a month, and that is real money," O'Toole said.