The deadline has passed, but it’s not too late! No, we’re not talking about taxes — hope everyone filed on time!

The deadline in question was the March 31st deadline marking the end of the open enrollment period for health insurance on the public exchanges. A related deadline was April 30th, the hard deadline for the “high risk” subset of the population with plans poised to be cancelled.

The public exchange enrollment numbers continued to tick upwards in the weeks following the March deadline, reaching 8 million as of April 19th, 2014, the date the last official tally was reported. While enrollment numbers are slowing, it has become clear that even though the deadline has passed, some people continue to enroll.

The exceptions to the original deadline were well-documented — “high risk” patients, people in states with glitch-ridden exchanges, people who started to enroll before the deadline, but were not able to complete their applications, and people who were insured under a group health plan that is dissolving.

A lesser known fact is that the deadline for employer-sponsored insurance is similarly flexible. While October is typically when employer-sponsored health insurance is open for enrollment, many different situations merit exceptions and enable employees to enroll year-round. Here are just a few:

  • Starting a new job and enrolling in a health plan with a new employer for the first time
  • Leaving a job and losing employer-sponsored insurance
  • Getting married and wanting to add a spouse to an employee’s coverage
  • Turning 26 and becoming ineligible to be on one’s parents’ insurance

Bottom line, even though the deadline passed long ago, it was not a firm one and people without insurance still have options.

Are you one of them?

Under the ACA, it’s well understood that the cost of health insurance varies depending on your income, which determines how much of a government subsidy you qualify for, if any.

But that’s not the only variable: it also depends on where you live.

To give a sense of just how different the price can be, in the Minneapolis-St. Paul region, a 40-year-old will pay $154 a month for a PreferredOne plan, which is a silver-level plan on Minnesota’s state-run exchange, MNSure. Just across the border into Wisconsin, that same level plan — with a different insurer, doctors and hospitals — costs nearly three times as much.

Why such a difference?

According to Kaiser Health News, the least expensive areas “tend to have robust competition between hospitals and doctors, allowing insurers to wangle lower rates.” In these less expensive areas, doctors also tend to be salaried, rather than being paid by procedure. This removes the financial incentive to perform more procedures, saving money from the get-go.

Cost savings also come in areas with health systems that organize patient care in a cohesive way, rather than being a loose collection of specialists working in isolation. This type of health care network — sometimes called “integrated care” — fosters collaboration between all types of caregivers, from primary care doctors, to specialists, to nurses.

The most expensive areas for health care tend to be rural and isolated. These areas often have just one or two hospital networks, which allows a network to set prices without the price-controlling factor of competition.

Does high cost equal high quality?

Not necessarily. Higher cost, for example, does not guarantee higher quality. Consider areas such Aspen or Vail, Colorado, which are isolated and have just one hospital network. Residents of these areas will pay more due to the lack of competition, but that does not mean better care.

In fact, the best bet for affordability and quality lies in dense, populated areas where many insurers and provider networks exist — with lots of doctors and hospitals to support the population and which, therefore, must compete for business.

So while Aspen may be a good place to be a ski bum, it isn’t the best location for low-cost health care.

[See the complete list of the 10 least expensive areas to buy health insurance here. For the 10 most expensive, go here.]

Though the open enrollment deadline has passed, the number of people successfully enrolled in plans continues to tick upwards. Analysts predict that if the current rate of signups continues, eventually we’ll have as many as 30 million more people who will be newly insured. Right now, we don’t have enough primary care physicians to meet this new demand. There are many possible solutions. We’re exploring 3 of them in a series of posts:

1. Shortening the amount of time it takes to get a medical degree and expanding residency programs to get more doctors into the workforce more quickly.

2. Empowering medical professionals to take on more of the responsibilities of primary care physicians, working under their supervision. These professionals include physicians’ assistants, nurse practitioners, pharmacists, nurses and others.

3. Using technology – telephones, email and telemedicine — even remote monitoring — to extend the reach of physicians — especially for people in remote and rural areas.

This is Part III of a 3-Part Series. Click here for Part I and here for Part II in the series.

So far in this series, we’ve explored ways to get more physicians on the job more quickly and enabling other health care professionals to perform some medical services as the answer to the primary care physician shortage in this country. However, there is one option that doesn’t require adding more people to the mix at all. We’ll give you a hint: it involves the Internet.

According to the U.S. Department of Health and Human Services (HHS), more than three-quarters of rural communities in the U.S. have less than one physician serving every 3,500 residents.

So while adding more doctors to the pool may relieve shortages in urban hospitals or bring more specialists to the suburbs, it won’t have the same effect in towns and villages far off the beaten path.

As a result, many people who live in remote areas must travel hours to get to a doctor’s office or hospital. For them, a doctor’s appointment may never be convenient. The physicians who do work in rural communities must perform a broad scope of services — on any given day handling “everything from atrial fibrillation to pneumonia, and an asthma exacerbation to a cesarean section birth.”

Here’s where the Internet comes in.

Making it possible for physicians to “examine,” diagnose, and treat their patients remotely via devices included under the umbrella term “health information technology” (HIT) may be the answer providing primary physician care to these remote communities. It’s called telemedicine and it’s growing in use and popularity.

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