December 12, 2013:
The government asked insurers to grant people extra time to buy health insurance to gain coverage by Jan. 1.
“There’s still ample time for folks to research their options, talk things over with their families and select a plan,” Health and Human Services Secretary Kathleen Sebelius said Thursday. People may sign up until Dec. 23 for Jan. 1 coverage. “We’re recommending that insurers extend this deadline further,” she said..
The changes announced by Sebelius are aimed at preventing gaps in coverage for those buying insurance through the federal and state exchanges, which are websites where people can buy insurance. The federal exchange, which opened Oct. 1, has been plagued by a series of problems that were declared fixed Nov. 30.
Insurers will be required to accept payment until Dec. 31 for Jan. 1 coverage, Sebelius said. People in the Pre-existing Condition Program, a pool for insurance customers with pre-existing medical conditions, may stay in their plans until Jan. 31.
Almost 86,000 people are in that program, said Chiquita Brooks-Lasure, policy director for the Center for Consumer Information and Insurance Oversight.
The Dec. 23 deadline had already been announced, but it’s official as of Thursday, said Michael Hash, director of the HHS Office of Health Reform.
Hash said the HHS is asking, not requiring, insurers to consider offering retroactive coverage for some customers. For example, a customer who pays for insurance Jan. 5 could be insured retroactively to Jan. 1. That would allow that policyholder to receive a federal subsidy to help pay for the insurance.
Customers having a hard time enrolling because of the website’s problems may fall into a special category that allows them to sign up later, said Julie Bataille, communication director for the Centers for Medicare and Medicaid Services.
The changes announced Thursday could affect several groups of people facing gaps in coverage, said Matt Eyles, executive vice president of Avalere Health, a consulting firm. They include those whose individual policies were canceled because they did not meet the rules set by the Affordable Care Act; those affected by the end of the Pre-existing Condition Program; patients in Medicaid programs being scaled back and beneficiaries of programs for uninsured HIV and AIDS patients.
He’s afraid people are “sitting on the sidelines saying they’re going to wait until the website gets figured out and fixed.”
A gap could cause huge problems if diabetics or those with heart disease are unable to get their medications; or if someone coming off Medicaid doesn’t understand he’s no longer covered and injures himself in January; or for someone undergoing cancer treatment whose coverage stops Jan. 1.
To avoid those issues, the HHS has:
•Asked insurers to allow people to use out-of-network providers if the provider was listed as in-network when a consumer signed up for insurance.
•Asked insurers to refill prescriptions through January if those prescriptions were covered under previous plans.
•Asked providers and insurers to help educate people about their options if they find themselves with an insurance gap by not enrolling by Dec. 23.
Bataille said officials continue to see low error rates and high volume this week on the exchange site. HealthCare.gov is capable of handling 800,000 people a day.
“We’ve had days already where we’ve had more than that,” she said.