Individuals looking to purchase insurance through HealthCare.gov will have until Dec. 23 to enroll and be benefits eligible on Jan. 1.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced Thursday, Dec. 12, that additional steps will help ensure that consumers who are seeking health insurance through the Health Insurance Marketplace will be able to transition to new coverage.
The steps taken Thursday include:
- Requiring insurers to accept payment through Dec. 31 for coverage that will begin Jan. 1, and urging issuers to give consumers additional time to pay their first month’s premium and still have coverage beginning Jan. 1, 2014.
- Formalizing the previously announced decision giving individuals until Dec. 23, instead of Dec. 15, to sign up for health insurance coverage in the Marketplaces that would begin Jan. 1.
- Giving people enrolled in the federal Pre-existing Condition Insurance Plan (PCIP) the chance to extend their coverage through Jan. 31, 2014, if they have not already selected a new plan.
PCIP is a transitional bridge program that provides people with health conditions who could otherwise be shut out of the insurance market or charged more because of their pre-existing condition quality, affordable health insurance until options become available in the Marketplaces. The additional month gives this vulnerable population additional time to enroll in a plan and ensure continuity of coverage, according to HHS.
The agency will also “strongly encourage” insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes, as well as encouraging insurers to refill prescriptions covered under previous plans during January, but those decisions will ultimately be made by each individual insurance company, and are not part of the legal mandate of the Affordable Care Act.
Rick Welsh, president of Welsh and Associates, a Kansas City-based health care and insurance consulting business that works with OOIDA’s Medical Benefits department, said the Dec. 23 deadline applies to all insurance carriers and products that are offered through the federal exchange.
However, some insurance companies, such as Assurant, are not on the federal exchange, and are still operating on an enrollment deadline of Sunday, Dec. 15, for coverage to begin on Jan. 1.
“Any carrier and all products on the federal exchange are required to honor that,” Welsh said in a phone interview with Land Line on Friday. “Assurant is an off-exchange product, meaning they do not have to honor the Dec. 23 deadline. If you’re not buying on the federal exchange from HealthCare.gov, you need to ask about the deadlines.”
OOIDA is operating its own private exchange for members in six states, and Welsh said the Association’s exchange is “up and running” in all six states.
“We can give people quotes in six states,” he said. “Two states have multiple carriers. By the end of the year, we’ll have all six states with multiple carriers. With Assurant on board we’re going to have 41 states on the exchange by the first of the year.”
In addition to Assurant, Welsh said the OOIDA exchange also offers health care plans from Blue Cross Blue Shield of Kansas City, and Blue Cross Blue Shield of Texas.
The six states currently in the OOIDA exchange program are Illinois, Indiana, Kansas, Missouri, Ohio and Texas. Welsh said it should be noted that customers who purchase health insurance through a private exchange such as the OOIDA’s are not eligible for federal tax subsidies. In order to qualify for the subsidies, insurance must be purchased through state or federal exchanges. Furthermore, those applying for subsidies must fall between 133 percent and 400 percent of the federal poverty level in order to qualify.
The Kaiser Family Foundation offers an interactive subsidy calculator on its website, to help determine whether an individual or family may qualify for the tax break.
Consumers with questions are encouraged to call the HHS call center at 800-318-2596 or visit HealthCare.gov where they can find local help.