The start of open enrollment on the state's online marketplace for health insurance went smoothly Sunday, officials said, with almost 780 people signing up by late afternoon and many others calling for information or meeting in person with professional advisers.
The Maryland health exchange launched free of the technical problems that disrupted enrollment in the first enrollment season beginning in the fall of 2013.
Performance improved in 2014. Consumers this time were promised a user-friendly website, a simpler application and better access to knowledgeable brokers to help them choose plans, exchange officials said.
Those moves were expected to help the state reach a goal of signing up 150,000 people in private plans, up from 115,000 last year.
"It was a good first day," said Andrew Ratner, exchange spokesman. "Especially being a Sunday."
By 4 p.m., 834 people had enrolled, including 493 in private plans and 147 in Medicaid, and 194 in dental plans.
Engineers redesigned the website with icons to explain terms that had confused some people. Brokers were hired to answer complicated and time-consuming questions.
After focus groups found that people wanted more in-person help, more storefronts were planned where residents could sign up for insurance. And more outreach was scheduled for some areas, with navigators headed to churches and other meeting places.
"Imagine if you have never had to use a health insurance plan" and don't understand co-pays and deductibles, said Mark Romaninsky, program director for the group Seedco on the upper Eastern Shore. "That can be intimidating for people. That may be why some people haven't jumped in yet. That's why outreach and education is an important part of what we do."
People trickled into an enrollment event staffed by Seedco at the Harford County library branch in Abingdon on Sunday afternoon and found navigators ready to explain the process.
Fidel Suarez, a 25-year-old who recently changed jobs and lost his employer coverage, realized he still needed health care after injuring himself during a soccer game. He's not sure if he'll qualify for coverage in his new job.
He discussed the options with Sue Ehlenberger, a Seedco lead navigator.
"I'm not invincible," he said. "She told me the steps to sign up if I need to."
Po Cha stopped in with his wife, Jung, to find out what they needed to do to keep their insurance. The family had been on Medicaid, the government insurance program for low-income people, but his new job in September meant changes.
Navigator Pat Donovan advised them to shop around.
Cha made an appointment to enroll next week.
"I'll check out the website and see what's good for my family before then," he said.
This year, for the first time, consumers who bought exchange plans last year can automatically re-enroll in the same plans. But they might face higher premiums.
Exchange officials aren't sure how many people will opt to roll over their plans. About 100,000 are eligible because they had no job or family changes that could affect subsidies or coverage. Letters have been sent explaining any increase in premiums or changes to subsidies if they stay the course.
The state's insurance commissioner and some analysts suggested that most people look at other plans. While CareFirst BlueCross BlueShield, the exchange's dominant insurer, raised many of its rates, others didn't raise them as much or even lowered them.
"People can stay where they are if they want, but for financial reasons, I would be careful about that," said Karen Pollitz, a fellow with the Kaiser Family Foundation.
CareFirst received the blessing of the Maryland Insurance Administration in September to raise rates by up to 26 percent on average, a hike the insurer said was needed to absorb more than $100 million in losses incurred as more older and sicker patients received coverage under the Affordable Care Act.
Under that rate increase, a 40-year-old who lives in the Baltimore area will pay an additional $275 a year on average for CareFirst's HMO silver plan, which pays 70 percent of medical costs.
The rates do not take into account subsidies that help most people defray premium costs.
Other insurers are cutting rates. Two plans offered by United HealthCare on the individual market are slated for rate declines of 0.5 percent and 3.2 percent. The administration granted a 3.3 percent rate decrease to a Cigna plan.
A plan offered by Kaiser Foundation Health Plan of the Mid-Atlantic States was granted a 10 percent increase. Plan officials had sought a 4.8 percent increase, but the insurance administration said they had not considered certain risk adjustments.
Evergreen Health, a health co-op, was granted a 9.5 percent rate increase.
At the time, Maryland Insurance Commissioner Al Redmer said the rate hikes offer consumers "an opportunity to go back out and look at the marketplace."
"We have other carriers selling the exact product as CareFirst at lower rates, so it is a choice that consumers get to make," he said.
An estimated 308,000 eligible people in the state remain uninsured.
Research last summer found people still need to be convinced that the exchange now functions properly and that policies are affordable.
The exchange also has identified pockets of resistance, particularly in the Washington suburbs, Southern Maryland and the Eastern Shore, where people aren't enrolling despite rising penalties.
"Spending any extra on insurance can be a strain on some families," said Seedco's Romaninsky. "They are taking the chance and betting they will be healthy next year. Because even if the plan is more affordable than if you were to pay for a doctor's visit outright, that extra cost each month may not seem doable."
Some might have more incentive this year as the penalty for opting out increases. Next year's penalty is whichever is greater: 2.5 percent of gross household income or $695 per individual. That grew from the 2015 penalty of 2 percent of gross income or $325 per individual.
For the money, exchange officials are telling people, it makes more sense to get coverage than pay a penalty and not have insurance.
If outreach workers can better explain the costs and benefits, Romaninsky said, they have a better chance of convincing them to enroll.
Nine out of 10 people received subsidies to help pay for insurance last year, he said, but many uninsured may not know they are eligible for aid. Others may qualify for Medicaid and not know it. Seedco's navigators will continue their outreach at places such as libraries, unemployment offices and multicultural resource centers.
On the lower Eastern Shore, Kat Gunby coordinates outreach through the local health department. She said rural communities pose challenges because people live far apart and there is no center where they gather. Watermen are also hard to reach, and navigators might need to get on boats to seek them out. Many on the Eastern Shore work in the service industry or farm, and might not have time to take a few hours to visit a navigator at a storefront office.
Gunby said navigators piggyback off agricultural workshops where they know farmers will be, or appeal to people through newsletters run by local poultry industry associations.
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"It is all about building relationships with people who are a part of the targeted population," she said.
Open enrollment runs through Jan. 31. Carolyn Quattrocki, the exchange's executive director, said she expects an early surge, a lull and then another surge as deadlines approach to get coverage. For example, people must enroll by Dec.15 to get coverage by Jan. 1.
Kaiser's Pollitz said people should try to enroll early to avoid the last-minute crowds.
"The whole system gets jammed right before the deadline," Pollitz said.