HHS Asks Insurers for Leniency in Obamacare’s Opening Months

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

MIAMI, FL - OCTOBER 08: Affordable Care Act navigator Nini Hadwen (R) works with Marta Aguirre as she shops for health insurance during a navigation session put on by the Epilepsy Foundation Florida..
National Journal
Dec. 12, 2013, 11:26 a.m.

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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