MNsure has caused tears, frustration, and, yes, even joy in its users

Nov. 30--A couple in St. Louis Park expects to save more than $12,000 next year thanks to coverage available on MNsure, the state's new health insurance exchange.

A woman in Maple Grove, meanwhile, complains she spent hours working through glitches on the MNsure website only to find her family won't get a tax credit.

In St. Paul, a man who has had good luck shopping health insurance options in the past now is looking at a hefty premium increase for the fullest access to doctors and hospitals.

But in Edina, a woman who has been repeatedly denied commercial coverage due to health problems finally can shop for insurance options.

The anecdotes illustrate the range of consumer experiences among Minnesotans shopping this fall on the state's new health insurance market for people who buy coverage without help from an employer.

It's not a huge market -- currently covering about 5 percent of the state's residents -- but those consumers have been in the spotlight over the past month because of big changes with their policies because of the federal Affordable Care Act.

Much of the controversy has focused on consumers facing huge premium increases -- or, in some states, outright policy cancellations -- due to the changes. Interviews with a half-dozen Minnesota consumers show that while some people here are clear financial losers due to the health law, others will be better off.

The mixed results were forecast by a state-commissioned study that was released about two years ago, said Scott Keefer, vice president of policy and legislative affairs at Eagan-based Blue Cross and Blue Shield of Minnesota, the state's largest carrier in the individual insurance market.

"If you look back to the modeling that was done for the state, they said that after tax credits 70 percent of Minnesotans would be either status quo or better off," Keefer said. "That means that 30 percent, according to their modeling, would have a different experience."

It's unclear, he added, whether that 70/30 ratio is holding true this fall.

BIG SAVINGS

Mike White has seen escalating health insurance premiums swallow a bigger and bigger share of his wages for years.

Even so, White and his wife have stuck with the same individual health insurance policy due to fears they'd be dropped from coverage if they tried to go elsewhere.

White's wife has a pre-existing health condition, and the one time they considered switching about 15 years ago they halted the process once they realized each spouse would be getting insurance through different policies.

"We were both really scared," said White, 61, of St. Louis Park.

This fall, when the Whites got their insurance renewal notice, it promised an increase of about 24 percent to $1,795 per month. The annual tab for the couple, in other words, would jump to more than $20,000.

That's unaffordable, White said. So, he contacted a health insurance agent who sat down with the couple as they shopped on the website of MNsure, the state's new health insurance exchange. It took about an hour, White said, for the couple to find a policy with comparable benefits and a premium of $921 per month.

Due to their income and age, the Whites qualify for a federal tax credit that discounts the out-of-pocket premium cost to $651 per month. So, rather than paying more than $20,000 next year, the Whites believe they will pay just under $8,000 for their new policy.

As the couple sat at a computer this fall looking at their new coverage with insurance agent Sheryl Frieman, things got a little emotional, White said.

"I had two women sitting their crying, and I'm sitting there saying: 'Yeah!' " said White, who is a third-generation milkman. "My wife and I have really been struggling to get by. ... This is going to turn our lives around."

BIG HEADACHES

In the days following the launch of the MNsure website on Oct. 1, Carrie Rocha made several frustrated attempts to use it.

Ultimately, the health plan options she found brought her close to tears. Whereas Rocha's family currently pays about $490 per month for coverage, comparable MNsure policies were available for $700, she said.

"I was just sick to my stomach," said Rocha, 38, of Maple Grove.

Next, Rocha tried to use the MNsure website to see if a tax credit might offset the premium costs. Under the federal health care overhaul, people with incomes up to four times the federal poverty level -- a threshold that works out to about $46,000 for an individual and $94,000 for a family of four -- have a shot at getting a tax credit.

But credits are based on more than income. The law caps the share of income that people at different income levels must pay for health insurance premiums, which vary by age. When premiums are more expensive than the cap, tax credits make up the difference. But when premiums fall below the cap, there's no tax credit.

Like many MNsure users this fall, Rocha learned the premiums she can find fall below the cap. So,there's no subsidy.

"I was shocked," said Rocha, who writes a consumer website called www.pocketyourdollars.com.

Jenni Bowring-McDonough, a MNsure spokeswoman, said the agency is aware with consumer frustration related to tax credits, and is currently double-checking calculations to ensure accuracy. Most of the problems that website users were experiencing in early October, she added, have since been fixed.

In the end, Rocha found a relatively good deal for coverage by purchasing directly from an insurance company, rather than going through the health exchange. Making the new deal affordable, however, has involved dropping dental insurance for Rocha and her husband.

"If I did qualify for a subsidy, then sure -- I'd apply through (MNsure)," said Rocha. "But it was not an easy one-stop shop. ... I couldn't compare options the way I wanted, and I couldn't easily get the information I needed."

PLEASANT SURPRISE

Mark Conklin was pretty sure his family's health insurance premium would go up next year.

Conklin is a St. Paul writer who was hired to help develop a website called myhealth carefuture.org, which a trade group for Minnesota health insurers launched this spring.

The website was an attempt to walk consumers through the various ways the Affordable Care Act is changing the health insurance market and how those changes affect premiums and out-of-pocket costs. Beyond eliminating pre-existing condition exclusions, the law limits deductibles and mandates certain benefits so the coverage is similar to what some in large employer health plans receive.

Based on his work developing the website, Conklin wasn't surprised when his renewal notice told him his premium would go up more than 20 percent. Still, it wasn't a good feeling.

"My insurance premium for a healthy family of three (was going to) exceed my mortgage by 20 percent, which just seems completely ridiculous," Conklin said.

For the heck of it, he decided to shop around on the MNsure website and found that by switching to a smaller health insurance company he could actually save about $100 per month. The new policy comes with a lower deductible, Conklin said, and the lower premium comes even though he won't qualify for a tax credit.

"It shows the full complexity of the law -- the good, the bad and the ugly," Conklin said of his situation. "First I get the bad news. Then I get the good news, and maybe the good news is because of added competition."

A 'KICK IN THE SHORTS'

Jeff Quinn has developed skills in how to buy health insurance.

For several years, Quinn has analyzed the trade-offs between premiums and deductibles to find the best deals for coverage after taking into account how his family typically uses health care services.

By dropping coverage for certain conditions, Quinn has been able to get a lower premium in the past. And his family's good health also has helped them find pretty good rates, he said.

But the shopping skills won't change the fact that coverage under the Affordable Care Act will cost him, Quinn said. The plan he's likely to select will cost an extra $1,800 per year in premiums and will leave the family open to more out-of-pocket costs when they use heath care services.

The family isn't eligible for a tax credit.

"It's a kick in the shorts," said Quinn, 44, of St. Paul.

Quinn is moving to a new insurance company because his current health plan is shrinking its network of doctors and hospitals where people can obtain services at the best rates. As he surveyed options for next year, Quinn said he recognized that such "narrow network" options might save him money in some cases, but he's wary of such a choice.

"If we dipped our toe outside that network, we were basically paying cash for it," Quinn said. That contrasts with the plan he ultimately chose, he said, adding: "We can go anywhere."

Quinn wonders if MNsure users recognize the network implications of their choices, adding: "You've really got to read the fine print."

CHOICES, AT LAST

Donna Devine said she knows the policy she's buying through MNsure doesn't provide low-cost access to all of her current doctors.

But the 48-year-old Edina resident said she's OK trading the access for a lower monthly premium and a lower deductible. Plus, she's thrilled at having a choice in health plans.

Devine has been covered by the state's high-risk health insurance pool following a breast cancer diagnosis in 2001. Commercial health insurance companies won't offer her a policy, even though there hasn't been a recurrence in her cancer for more than 10 years.

"I felt like I was being penalized for something I didn't really have any control over," Devine said.

Coverage through the high-risk pool comes at a premium that's set slightly above market rates. Now that pre-existing condition exclusions are gone, Devine can select from many policies and pay less -- even though she won't be receiving a tax credit.

"I will be saving at least $660 per year, and that doesn't include the savings I will receive with a smaller yearly deductible," Devine said this fall during testimony at a MNsure board of directors meeting in St. Paul. In an interview, she said the savings could fund out-of-pocket costs if Devine continues seeing doctors that aren't in her new health plan's provider network.

GLITCHES GALORE

Ken Koch doesn't like the idea of the federal government providing so many subsidies to people buying health insurance.

But if the money's available, he and his wife have decided they might as well take advantage of it.

Trouble is, they haven't been able to make the MNsure website work.

"Over the past month and a half, we've made 30 calls related to this with no success," said Koch, 59, of Columbia Heights. "We've tried everything."

Every time they go to buy a policy, the couple hits a roadblock at the final click.

"It just comes back with her name and not mine," Koch said, adding that MNsure workers haven't been responsive in helping get the problem solved.

Jenni-Bowring McDonough, a spokeswoman for MNsure, wrote in an email Wednesday that the problem "is a known issue that has been repaired. Consumers coming through MNsure now should not have this experience."

As for the concern about MNsure workers, she wrote: "We have increased staffing ... to better meet consumer call needs, and we strive every day to provide responsive customer service."

Koch said late Wednesday that he saw evidence of progress, since the couple's application finally is listed in the MNsure system as approved. "But when we go in to buy it, the system crashes," he said.

"Why didn't anybody tell us it was a known issue?" he added. "They would have saved us a whole lot of heartaches, if they would have just told us, 'This is a known issue -- we're working on it, but it hasn't been fixed.' "

Christopher Snowbeck can be reached at 651-228-5479. Follow him at www.twitter.com/chrissnowbeck.

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