Medicaid app stalls insurance sign-ups

A requirement that applicants for health insurance at the online Colorado marketplace fill out a Medicaid application is hindering the process, according to brokers using the system.

The Medicaid application is a “mammoth impediment to Coloradans being able to get the advance premium tax credit,” said Randy Pifer of Active Insurance Solutions, 940 Grand Ave.

The Medicare application, known as the Program Eligibility and Application Kit, or PEAK, was introduced as a requirement to obtain health insurance on about two weeks before the Oct. 1 rollout of the program, which is aimed at providing Coloradans with a way to meet the federal requirement that individuals have health insurance by Jan. 1, 2014.

That was about the time that criticism was being leveled at the federal program for acknowledging that applicants would be on the “honor system” in seeking the advance premium tax credit, which depends on income. Federal officials said they couldn’t verify every applicant’s income claims.

“When things fell apart on the federal side,” Colorado had to rely on the PEAK application, said another broker, Terry Toner of Mountain West Insurance & Financial Services, 4870 W. Park Drive, citing conversations with the state marketplace.

That wasn’t the case, said Ben Davis, spokesman.

“No, not at all,” Davis said in an email. “We went with the full PEAK Application to ensure accuracy in the determination process. Had nothing to do with the Federal end of the exchange.”

Toner is avoiding using PEAK because “that whole system is being totally overrun right now,” he said.

One problem with PEAK is that it’s universally required, Pifer said. The application would be better used for applicants “on the bubble,” those who might be within a few thousand dollars of obtaining an advance premium tax credit, Pifer said.

In many cases, W-2 forms make it clear who will or won’t be eligible for the tax credits, as well as the amounts, Pifer said.

If applicants fudge their numbers, their tax records eventually will catch up with them, he said.

He’s also concerned that the PEAK application is intrusive and unreliable, Pifer said.

One customer was denied a tax credit after spending 40 minutes on the phone with a counselor, even though the applicant’s three-member household income of about $40,000 was well below the $72,000 threshold, Pifer said.

“Somebody needs to explain that to me,” Pifer said. “People need to get worked up over this,” he said of the PEAK application. “This is not necessary.”, meanwhile, is significantly better and much quicker than when it was first rolled out, he said.

Toner, meanwhile, is working to enroll individual and small-group customers as quickly as he can so they can obtain coverage as of Dec. 1, a month before the federal mandate kicks in.

“Rocky Mountain Health Plans has the best rates” for the first quarter of 2014, with Anthem Blue Cross also in the mix, Toner said.

“It’s extremely crazy and confusing,” Toner said. “If I can hide (customers) from Obamacare for 11 months, I’m getting them enrolled in December.”


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This piece is pure opinion designed to scare people away from the exchange.  I was shunted to PEAK when I applied for insurance at the exchange.  Anyone who keeps the records needed to fill out their tax return can fill out the PEAK forms easily.  I had one question, which took two days to answer because someone at the local Human Services office was on vacation.  That wasn’t an issue because PEAK has a “Save and Return” button that lets you leave and come back where you left off.

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