Here’s a primer on an item in the news this past week on the Affordable Care Act — and what it means to you. The focus: steps to smooth the transition to new health plans.
Q: Has the deadline just changed for choosing a health plan if I want to have insurance starting Jan. 1?
A: Not exactly. The sign-up deadline had previously been moved from Dec. 15 to Dec. 23, because so many people were having trouble this fall trying to use HealthCare.gov. On Thursday, Health and Human Services Secretary Kathleen Sebelius tried to give people a little more wiggle room. She asked participating insurance companies to let people who sign up a bit after Dec. 23 to have coverage as of New Year’s Day. But the government can’t order insurers to do that, and the official deadline hasn’t changed.
Q: Aren’t there some people who definitely get more time?
A: Yes, but not very many. If you are in the federal Pre-existing Condition Insurance Plan (PCIP), you have just gotten an extra month — until the end of January — to switch to a new health plan. PCIP is temporary insurance that began three years ago for people who had been rejected by insurance companies because they have expensive-to-treat ailments. PCIP was supposed to end Jan. 1, when it will become illegal for insurers to discriminate against people who are sick. But not everyone in PCIP — about 85,000 people — has gotten new insurance. So, the government created a one-month grace period, rather than possibly stranding some sick people with a gap in coverage.
Q: But what about more time for the rest of us?
A: The government has given a big “maybe.” A federal rule written earlier this year says that HHS can give a “special enrollment period” to people who tried to buy coverage but failed because of “an error” in the marketplace. No one has said exactly what that means — how people could ask for special time or when the government would allow it.
Q: Is there something new about how long I have before I need to pay?
A: Yes. Under the new insurance marketplaces, coverage won’t begin until you have paid at least one month’s insurance premium. Before now, the government had not spelled out when you needed to pay to be guaranteed of getting Jan. 1 coverage. And health plans had set their own dates, from late December through early January. On Thursday, the government told all the health plans that as long as customers pay by Dec. 31, coverage must start Jan. 1.
Q. Could I have even more time to pay that bill?
A: Perhaps. Insurers are being asked — not ordered — to cover people as of New Year’s Day even if they don’t pay their first premium until January. Same for people who pay just part of their first bill by Jan. 1. Either way, the deadline for enrolling is still Dec. 23.
Q: How about if I’m one of the people whose old insurance is being canceled?
A: The government is asking insurers to cut down on potential bumps in the road as people switch from canceled health policies to the new health plans. For one thing, HHS is urging insurers to let new customers refill their prescriptions during January, even if a drug isn’t covered under the new plan. The government also is asking insurers to let patients keep their current doctors — at no extra cost — for “acute episodes” or if a doctor dropped out of a health plan after a customer signed up.
Q. So how does all this affect me if I live in Maryland, the District or another state that is running its own insurance marketplace?
A: Rules vary in the states running their own exchanges. In Maryland, as long as you enroll by Dec. 23, you can pay as late as Jan. 15 and get coverage retroactive to the first of the month. In the District, you must sign up by Dec. 23, but the three insurers taking part in DC Health Link have all set different payment deadlines.