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HHS Asks Insurers for Leniency in Obamacare’s Opening Months HHS Asks Insurers for Leniency in Obamacare’s Opening Months HHS Asks Insurers for Leniency in Obamacare’s Opening Months HHS Asks Insurers for Len...

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Health Care

HHS Asks Insurers for Leniency in Obamacare’s Opening Months

Sebelius wants them to allow late payments for those who miss Jan. 1 deadline.

HHS is asking insurance companies to provide retroactive coverage for consumers who sign up on the exchange but don't pay their premiums on time.

photo of Clara Ritger
December 12, 2013

The Obama administration is "strongly encouraging" insurance companies to cut consumers a break during the first few months of Obamacare coverage.

The Health and Human Services Department announced Thursday it would require insurance companies to accept premium payments through Dec. 31 for Jan. 1 coverage. The department is also pressuring the companies to allow partial and late payments for those who miss the deadline.

"We strongly encourage insurers to adopt these types of mitigation strategies," said Chiquita Brooks-Lasure, deputy center and policy director at the Center for Consumer Information and Insurance Oversight. "Many insurers do retroactive coverage in the current market."

 

Among other requests to insurers, HHS would like them to treat out-of-network providers as in-network providers in cases of emergency, and is asking them to cover prescriptions that consumers previously received through January, in the event they are not covered under the consumer's new plan choice. HHS is requesting that insurers maintain up-to-date provider directories so that consumers know which doctors and hospitals are covered and which ones will mean further out-of-pocket expense.

HHS is also asking insurance companies to allow retroactive coverage, so that if people sign up and pay their premiums in January, they can receive reimbursements for covered expenses incurred on or after Jan. 1.

Insurance companies do not have to go along with these requests, however. When asked if any had agreed to the new terms, Brooks-Lasure said Aetna would allow consumers to pay premiums through Jan. 8.

For its own part, HHS is giving Americans enrolled in the Preexisting Condition Insurance Plan until the end of January to buy coverage in the marketplace. PCIP was created to insure people with serious medical conditions who could not previously get coverage in the bridge period between the Affordable Care Act's implementation and the start of the health insurance exchanges.

Roughly 86,000 people are enrolled in PCIP. HHS received a $5 billion allocation for the program and does not expect to exceed that total despite the monthlong extension. It has spent $4.74 billion to date.

HHS also finalized the rule to allow individuals in the federal and state-based marketplaces to sign up for coverage beginning Jan. 1 until 11:59 p.m. EST on Dec. 23.

The department could, however, extend that deadline again should extenuating circumstances arise. And people who try to sign up for health insurance by then but are unsuccessful because of issues with the marketplace can qualify for a "special enrollment period" to allow them to get insurance as soon as possible.

"We do believe the system is able and can handle 800,000 consumers per day," said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services.

How HHS determines who qualifies for "special enrollment" remains unclear.

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