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Shots - Health News
Tue March 11, 2014
Deadline Nears To Buy Or Switch Obamacare Coverage
People who got off to a rough start with Obamacare or haven't picked a plan still have options. But they better hop to it. The open enrollment period ends March 31.
Those who were unable to sign up for a marketplace plan because of the glitches with federal or state websites can receive coverage retroactive to the date they originally applied. There are also retroactive premium tax credits and subsidies, the federal government said in late February.
In addition, some people who gave up on enrolling through their state's balky marketplace and instead bought a plan outside the exchange may be able to switch to a marketplace plan and qualify for retroactive subsidies.
The federal guidance leaves it up to individual states to decide whether they want to offer these options. The federal marketplace has its own process in place to bump back the effective coverage date for people who encountered those problems, says an official at the Centers for Medicare & Medicaid Services.
"This [guidance] raises more questions than it answers," says Sabrina Corlette, project director at Georgetown University's Center on Health Insurance Reforms. "From a consumer perspective, it says nothing about what difficulties you have to have had to qualify or what documentation you have to show."
In addition to difficulties enrolling, some consumers have been tripped up by inaccurate or incomplete information posted online about the benefits or providers available in a particular plan. They, too, may get some relief.
According to the federal guidance, if enrollees encounter "benefit display errors," such as inaccurate information about deductibles or coverage, insurers are encouraged to honor the information they displayed.
If the insurer fails to do so, and the misinformation might have affected a consumer's choice of plan, that person will generally be allowed to pick another plan at the same coverage level, offered by the same insurer. If consumers can't find a good substitute with that insurer, they'll have 60 days to select a new marketplace plan, the guidance says.
Similarly, if people have enrolled in a marketplace plan and then discovered that it doesn't include doctors, hospitals or other providers they need, they may switch to another plan at the same level offered by the same insurer, according to the federal rules. However, changes due to provider network issues must be made by March 31.
By the end of February, roughly 4 million people had signed up for a marketplace plan on the federal or state-based exchanges.
Picking a plan is only part of the process of getting coverage. Benefits only take effect when you pay your premium, says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. "If you've never paid your premium, your insurer doesn't consider you're covered," she says.
People who haven't enrolled by Mar. 31 may owe a penalty for not having health insurance in 2014.
In the past, people buying coverage directly from an insurer could generally sign up any time during the year as long as they got through the medical underwriting process that insurers used to evaluate applicants.
Not anymore. Consumers who don't sign up during the open enrollment period will generally have to wait until enrollment begins again next fall to sign up or change plans — unless their circumstances change, for instance, if they move, marry, or lose a job, among some of the more common examples.
There are a number of circumstances that may exempt people from penalties for not having insurance. The long list of exemptions covers things like affordability, incarceration and hardships such as being evicted or filing for bankruptcy.