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Avoiding health insurance gaps takes persistence

By The Associated Press

This article was published December 25, 2013 at 10:57 a.m.

CHICAGO — The deadline has passed, and so too the surprise grace period, for signing up for health insurance as part of the nation's health care law.

Now what?

For those who were able to navigate the glitch-prone and often overwhelmed website, there's still work to be done to make sure success online leads to actual coverage come the new year.

The first step experts recommend is to call your insurance company and double-check they received your payment.

What if you missed the Christmas Eve deadline and still want insurance in 2014, as the health law requires of most Americans? You may be without health insurance for a month, but you can still sign up for coverage that will start in February.

"Be patient, because they're trying to help you," said Tina Stewart, a 25-year-old graduate student in Salt Lake City who succeeded in enrolling in a health plan Tuesday morning. "It will take time."

The historic changes made by the Affordable Care Act take full effect on Jan. 1. People with chronic health conditions can no longer be denied health insurance. Those who get sick and start piling up medical bills will no longer lose their coverage. Out-of-pocket limits arrive that are designed to protect patients from going bankrupt.

But unless the 1 million Americans who have so far enrolled for coverage via the new marketplaces make sure their applications have arrived at their new insurance companies without errors, some may find they're still uninsured when they try to refill a prescription or make a doctor's appointment.

"The enrollment files have been getting better and more accurate, but there is still work that needs to be done," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group that represents the private insurance industry. "The health plans are still having to go back and fix some of data errors coming through in these files."

If everything went smoothly, consumers can expect to see a welcome packet arrive in the mail from their insurance company, Zirkelbach said. If not, a phone call to the insurer might clear things up.

"If a consumer signed up yesterday, they shouldn't expect the health plan to have their enrollment application today," Zirkelbach said. "Allow a couple of days to receive and process those enrollments."

Paying the first premium is crucial. Because of the changing deadlines for enrollment, most insurers have agreed to allow payments through Jan. 10 and will make coverage retroactive to Jan. 1, he said.

Anyone who missed the Christmas Eve deadline to enroll for insurance to start in January can still apply at for coverage to begin later. The federal website serves 36 states, but also directs people elsewhere to the online insurance site serving their state. The site also offers directions to local agencies offering in-person help.

After the disastrous rollout in October, the federal website received 2 million visits on Monday, and heavy — but not as heavy — traffic on Tuesday. White House spokeswoman Tara McGuinness said she had no immediate estimate of visitors Tuesday or how many succeeded in obtaining insurance before the midnight Christmas Eve deadline. The unexpected one-day grace period was just the latest in a string of delays and reversals.

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cliffcarson says... December 25, 2013 at 11:51 a.m.

I call the one day deadline extension "something good". I would call a one Week deadline "something really good".

It should be evident that people want to get enrolled. The White House and the Democrats in Congress wants people to get enrolled. It is left to the Republicans to be Naysayers.

Those who opt for the penalty should realize that paying the penalty doesn't give them coverage. Of course they are not liable for a penalty if they are covered by an employee plan or other recognized plan. But if they don't have coverage, they are betting they won't need it. However , if they do need coverage, that is when they could pay the critical penalty. It could change their life forever.

When we were in our twenties my wife was in an automobile accident that had her in the Hospital for 71 days and on recovery care for two years.. Don't even try to guess what that bill ran to. But we were covered. By a Government plan no less. We didn't have to pay a nickel out of pocket.
Give it some thought.

For those of you who think you will never need it,

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NoUserName says... December 25, 2013 at 12:44 p.m.

What's to stop those people from simply signing up when they DO need it? There are no more pre-existing condition exclusions for those that have insurance gaps.

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cliffcarson says... December 25, 2013 at 5:04 p.m.

I am thinking that there is a provision that sigh-ups have time frames. If so this would prohibit someone to sign up only when they need coverage. For example, If one doesn't sign up by the deadline then they will not have coverage beginning on January 1. So an accident on January on say January 12th wouldn't be covered. In other words you must have insurance when you encounter a need for it.
Refusal to sign up is not a pre-existing condition.
Also something to consider, if you choose to pay a "no insurance" tax you are not eligible to enter into the plan until the next sign up period. Anything that happens during that period of insurance refusal is not covered.
And those who do this are paying a "tax" that is based on the rate of premium that would be required to be paid by someone covered, and therefore all of these taxes would go to offset the actuarial cost of those not participating in the plan, because no claims would be paid out of those non participation taxes. It would operate the same as someone signing up to avoid the tax but not paying their premium for the coverage.

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Delta2 says... December 25, 2013 at 10:51 p.m.

Cliff, regarding your first comment, I am glad that your wife came out OK as well as for the fact that you didn't pay a nickel. However, have you looked at some of these plans offered on the exchange? There are some seriously high deductibles. Anyone who signs up for one of them is going to have a lot more than a nickel out of pocket.

Please don't take that as a complete criticism of the ACA; I admire the intention. It's the planning and execution with which I have a problem. To me it looks like Big Insurance is the only real winner here.

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cliffcarson says... December 25, 2013 at 11:54 p.m.

And I think you are right Delta.

I mentioned single payer in one of these threads about Obamacare. And when I mentioned it I said that the American people let the Republican Party scare them off of single payer and Government run Insurance.
The policy my wife had was a State mandatory participation plan. Had to pay 1% of my income for it. It had a deductible for sickness but not for accident. Did not cover drugs unless administered in a Hospital or as an extension of a Hospital stay as in her case.
Now that we are Senior Citizens, we are on Medicare, with Medigap, and a Drug Plan. I carry Blue Cross Medigap, and Cigna for the drugs. For my wife and Myself the total cost is about $8,600 per year for the two of us. But the only non-covered expense is the Drug Co-pay and the donut hole. I wouldn't carry the Drug Plan if my wife didn't need so many drugs. We usually pay over $10,000 per year on things the drug policy doesn't pay.
The Medicare payroll deduction plan took payments from income up to seems like $108,000 before I would stop paying. Seems like Social Security was deducted on income up to about the same.
I retired and pay Medicare monthly premiums for my wife and myself. I think it is about $125 per month for each of us. The Medigap pays what the Medicare doesn't pay and it costs around $5000 a year for the two of us.
Since Medicare always collects more from Wage earners each year than it pays out in Medicare patient claims, ( I am careful to state it that way because Medicare funds are used for a lot more things than for just Medicare), it would be solvent in perpetuity if it only paid for Medicare expenses.
The cost of Administration for Medicare is about 4%. The Cost of Administration for Private Insurance Companies is about 20%. This is why we really need a Government Medical Plan. Medicare has shown that a good program can come from the Government and cost less than Private Insurance.
The Affordable Care Act can become the paved road to affordable medical care for all if we would take the private Insurance Companies out of it.

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flipflop says... December 26, 2013 at 5:58 a.m.

I said it a long time ago, this is a VERY poorly thought out plan by the Muslim Socialist in Washington. I am retired at 58 and I say NO THANKS! to this Osamacare crap. I will just keep my fed BCBS plan.

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KMS says... December 26, 2013 at 11:05 a.m.

I am surprised at the high deductibles because I thought that the ACA reduced those to around $2,500 but that may be after the 1 year extended period. Why would anyone pay for a plan that doesn't cover hospitalization or accident coverage such as what BCBS offers? They need to go back to non-profit as they were originally set up to be instead of a private insurance corporation. They pissed and moaned back in the 1980s about non being able to charge what they wanted for their plans. Well boo hoo. They, along with other insurance carriers priced themselves out of the market and offered high tier policies with minimum coverage. I too wished that we had Single Payer totally separated from employment. That should never be a condition of coverage. Something that is entirely portable - I've read that wages would go up due to companies not having to pay for insurance coverage in their benefits packages. It would be a win/win for everyone. Let's get through this GOP debacle, get the program running, then we can wholly change the system. But with the GOP denying appropriation for the ACA website in the beginning (had absolutely nothing to do with Sebelius) the website cluster would never had happened. But if you think it wasn't all by design - ala Kock brothers - I've got a bridge for sale.

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NoUserName says... December 26, 2013 at 5 p.m.

'The cost of Administration for Medicare is about 4%. The Cost of Administration for Private Insurance Companies is about 20%."
Misleading. Studies have shown that overall expenses - when EVERYTHING is counted - are more or less similar. The gap is NOWHERE NEAR what you imply here.

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Delta2 says... December 26, 2013 at 9:14 p.m.

NoUser, I'll take you at your word for that, but can you provide any references for those studies?

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BillSmithFreeSpiritMan says... December 26, 2013 at 11:38 p.m.

Yes we all would like to see references for those studies andnot just the one's from Heritage and Jim Demint.

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