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Sebelius takes new steps to ensure Obamacare coverage January 1

By Adam Aigner-Treworgy, CNN
updated 6:20 PM EST, Thu December 12, 2013
STORY HIGHLIGHTS
  • Obama administration wants to ensure those who buy coverage will have it by the New Year
  • New rules finalize previously announced decision to extend sign-up deadline
  • Health agency urges insurers to make coverage allowances
  • Republicans have raised concerns about enrollment and coverage time frames

(CNN) -- Health Secretary Kathleen Sebelius announced new steps on Thursday to ensure that people purchasing health plans on a new insurance exchange will have coverage starting on January 1.

The new rules finalize a previously-announced decision to extend the deadline to purchase insurance for coverage beginning at the start of 2014.

Originally consumers had to enroll in a plan by December 15 if they wanted coverage beginning January 1, but the new rule allows individuals eight more days, pushing that deadline back to December 23.

On a conference call with reporters, Director of the HHS Office of Health Reform Michael Hash also said insurers were now required to begin coverage on January 1 for all consumers who pay by December 31.

Government officials are urging insurers to set both their enrollment and payment deadlines even later, allowing coverage beginning January 1 for consumers who enroll after December 23 or pay all or part of their premiums after December 31.

Obamacare: You're not insured until you pay

"Aetna has said that they would allow payment as late as January 8," said Chiquita Brooks-Lasure, a senior official with the Center for Consumer Information and Insurance Oversight.

Previously insurers had been allowed to set their own payment deadlines at any time, but this ruling standardizes the payment process.

Given the shifting deadlines and the potential for different payment schedules for different insurers, Sebelius acknowledged that consumers will have to be extra diligent to ensure they are actually enrolled.

"We advise consumers to call their insurance company to make sure that their payment has been received and that they are indeed enrolled," Sebelius said.

Republicans have raised concerns about consumers who may believe they've enrolled in a plan, but due to technical problems or payment errors may experience a lapse in coverage in 2014.

Your Obamacare form might have errors

To address that, the administration reminded reporters about the existence of a "special enrollment period" for those who have trouble signing up due to a marketplace problem.

If a consumer tries to sign up before December 23 but runs into trouble, they may qualify for special consideration to get coverage.

HHS is also "strongly urging" insurers to make certain coverage allowances during January to help consumers make the transition to new insurance policies.

While not mandating these changes, the agency is urging insurers to cover out-of-network doctors or doctors who have left a provider network since open-enrollment began as if they were in-network, and encouraging insurers to refill prescriptions even if they may not be covered under a new plan.

"This transitional opportunity is really something that insurers are quite familiar with in working with their new enrollees who may be coming from a different policy that might have different coverage provisions," Hash said.

To help inform consumers, provider networks and lists of covered prescription drugs will now be available in the anonymous shopping feature, and the government is pushing insurance companies to make sure these lists are up to date.

In an effort to help some consumers with severe health problems, the government is also extending the Pre-existing Condition Insurance Plan for one month. According to Brooks-Lasure, the PCIP currently insures more than 85,000 people.

"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," Sebelius said on Thursday's call.

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