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A guide to Obamacare’s ever-changing deadlines

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition or sign up here to receive it straight from your inbox. Read previous columns here.

We're exactly one week away from a crucial Obamacare deadline -- sort of.

The deadline for enrolling in insurance coverage that starts on Jan. 1 is Dec. 23. That's eight days later than the initial deadline of Dec. 15. But it's also eight days before the deadline to actually get your first premium payment to your insurer, which is Dec. 31 -- unless your insurance company sets the deadline later.

Got all that straight? A lot of insurance shoppers, understandably, do not.

"There is massive confusion around deadlines," says Mike Perry, co-founder of research firm PerryUndem, who has traveled the country doing focus groups with uninsured Americans this past month. "March comes up. January is prominent. But nobody seems to know the deadlines."

This is a bit of a tough spot for the White House, figuring out where to set the deadlines for signing up for Obamacare. With's rocky launch, the Obama administration has erred on the side of giving shoppers a bit more time to enroll in coverage. That's meant pushing back the deadlines for enrolling in coverage, beyond what was advertised way back in October.

That decision gives consumers more time, but it also has drawbacks: Consumers end up confused about what they need to do by which date. I've heard this in the interviews I've done with uninsured Americans, and Perry says he hears it a lot in focus groups.

"They know they're supposed to do something by January 1," he says. "A lot think if they don't have something, they'll get penalized. They're unclear about the cause and effect timeline."

So, for the confused, here are the deadlines, and what they do and don't mean:

The first important day is next Monday, Dec. 23. That's the last day that insurers are required to accept enrollments for coverage that begins on Jan. 1. In practical terms, this means that a shopper needs to click "enroll" by midnight that Monday in order to gain a policy that starts the next month.

That isn't, however, the only necessary step: That same shopper also needs to pay for their insurance plan in order for the benefits to kick in. And that payment is due to the insurance plan by Dec. 31. This is a more recent development: Up until last week, it was the insurance company that got to decide the last day it would accept payment. But under new rules proposed last week, the health plans are now required to accept payment through the end of the month.

Plans are, however, allowed to extend that deadline later if they so choose. This means they would accept payment for a January plan even after the new year had started. Officials at Health and Human Services say Aetna, for example, has agreed to accept payments through Jan. 8.

And, to put all of this in context, none of this is a final deadline for gaining coverage under the health-care law -- nor will you be slapped with a penalty if you're found roving the streets on New Year's Day without an insurance card in hand. Open enrollment on the exchange runs through the end of March. The White House has previously announced that as long as you've signed up for coverage by March 31, you will not face a penalty for going without a plan in the winter.

In future months, shoppers will need sign up by the 15th in order for it to take effect the following month. In January, for example, shoppers will need to enroll in coverage by Jan. 15 for it to take effect in February. If they decide to buy on Jan. 16, the coverage won't kick in until March.

That's, at least, where things stand right now. But as we've learned lately, Obamacare's deadlines are not set in stone -- and are certainly subject to change.

KLIFF NOTES: Top health policy reads from around the Web.

Insurers crank up Obamacare advertising. "Wellpoint —which has held off for weeks on a planned campaign as problems with the website made it impossible for many consumers to sign up— said it expects to spend up to $100 million by the end of this year on TV, social media and print ads targeting mostly young and healthy people—the consumers it covets most because their premiums will help offset the medical costs of older, sicker policyholders." Timothy W. Martin in The Wall Street Journal. 

California's exchange is struggling to enroll Latinos. "California has surged ahead in implementing the federal health-care law, but it is lagging in one way that could have major implications for the program’s success: Latinos appear to make up only a small fraction of those who have signed up. The numbers have prompted concern because so many of the state’s uninsured are Hispanic, and it could be a sign that enrollment efforts targeted toward Latinos are behind nationwide as well." Sandhya Somashekhar in The Washington Post.

How do we fix the primary care doctor shortage? "It turns out that the real bottleneck is at the post-med-school step: residencies, those supervised, intensive, hazing-like, on-the-job training programs that doctors are required to go through before they can practice on their own. There has been little growth in residency slots; they totaled 113,000 in 2011-12, from 96,000 a decade earlier. Exactly why residencies have not increased faster is a subject of great debate in the health care industry." Catherine Rampell in The New York Times.