Updated 7:14 p.m.
In a sign of how seriously website enrollment problems have hampered implementation of the new health care reform law, federal officials announced a raft of December deadline extensions Thursday, just weeks before new coverage under the law is set to begin.
“The steps we’re taking today will help ensure that Americans seeking quality, affordable health coverage can do so with even more peace of mind and with even more confidence that it will be there when they want and need it,” Health and Human Services Kathleen Sebelius said on a conference call with reporters.
But altering deadlines just 19 days before new health insurance compliant with the Affordable Care Act is set to begin seems unlikely to give Americans struggling to sign up much peace of mind, even if they do now have slightly more time to get coverage and pay premiums.
Federally-run high-risk pools funded by the ACA that provide coverage to some 85,000 Americans with pre-existing conditions will continue operating until Jan. 31, 2014. They were scheduled to shut down on Dec. 31, but consumer advocates had warned that some enrollees were struggling to navigate the federal enrollment website HealthCare.gov and risked having a gap in coverage in January.
The Department of Health and Human Services had already extended the deadline to sign up for January coverage from Dec. 15 to Dec. 23. But in a fact sheet distributed to reporters Thursday, the department said it may extend that deadline further “should exceptional circumstances pose barriers to consumers enrolling on or before December 23.” Insurers typically begin coverage the first day of the month after a consumer signs up for a plan. Federal officials said Thursday that those who “experience an issue” signing up for coverage who miss the Dec. 23 deadline will not have to wait until Feb. 1 for a plan to begin, but qualify for “a special enrollment period” allowing coverage to start “as soon as possible.”
Federal officials announced earlier this week that about 250,000 signed up for private health insurance through HealthCare.gov and state-run ACA exchanges in November, after about 100,000 signed up in October. Those figures are far below HHS enrollment targets and far fewer than the number of Americans who buy coverage independently and have seen their plans canceled this fall because they do not comply with the health law. Thursday’s deadline extensions seemed aimed at avoiding a situation in which fewer Americans have commercial health insurance in January 2014 than had it in January 2013, which could serve as an indictment of a law meant to vastly expand coverage.
In a move sure to rankle insurance companies, HHS said it is requiring insurers to cover consumers beginning Jan. 1 if they pay for their first month’s premiums by Dec. 31. The department also said it is “encouraging” insurers to offer retroactive coverage to consumers who sign up even later. “For example, if a person signs up and pays on January 5, they can have coverage with a start date of January 1,” HHS said in its fact sheet about the new deadlines. HHS is also urging insurers to cover those on Jan. 1 who have paid what Sebelius described as a “down payment” on that month’s coverage.
In a statement, Karen Ignagni, head of the lead trade organization representing insurers, warned that the latest deadline changes could add to existing problems with enrollment. “With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process. Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with HealthCare.gov.”
In addition to problems enrolling in coverage through HealthCare.gov, which is managing signups for 36 states, consumer advocates have complained that provider network and covered drug lists posted online through ACA exchanges have been ever changing and inaccurate. Some insurers have altered the list of doctors and hospitals included in their networks after plans went on sale Oct. 1. This means consumers who purchased plans believing their doctors and medications would be included may find out their plans do not cover these in January. HHS has asked insurers to treat out-of-network providers as in-network if the providers were listed as in-network when a person signed up for a plan. The department also asked insurers to cover prescription drugs in January if they were included in a previous plan but excluded from 2014 plans and urged insurers to treat out-of-network providers as in-network in January for patients in the midst of acute care.
It’s unclear if insurers will comply with HHS’s new requests, which will further complicate an enrollment period that has bordered on dysfunctional due to computer problems with HealthCare.gov.