U.S. bends rules over health-plan gripes

WASHINGTON - President Barack Obama’s administration has quietly reworked rules and computer code for healthcare.gov to try to stem an outpouring of discontent by some Americans who have discovered that the health plans they bought do not include their old doctors or allow them to add new babies or spouses.

Under changes that have not been disclosed to the public, the government will temporarily allow consumers who have gotten coverage through the online insurance exchange to switch health plans to a limited degree.

In a memorandum distributed Thursday night to insurers, federal health officials said people may pick different health plans before the end of March if they are dissatisfied with the ones chosen, but only if they stay with the same insurer and generally the same level of coverage.

The 14-page memorandum, obtained by The Washington Post, also says people will be given more freedom and a longer opportunity to get new health plans if they can prove that healthcare. gov, the website for the new marketplace, displayed inaccurate information about the benefits that a health plan offers.

In addition, healthcare.gov now is equipped with a “Report a Life Change” button, the memorandum says, enabling people to tinker with their insurance plans if they have added members to their family, moved, gotten out of prison, or undergone other changes that affect the insurance they want.

For the first time, people will be able to end their coverage with two weeks’ notice. And a computer flaw has been fixed in order to stop a problem known as “looping” in which some people have been shuttled back and forth between the marketplace and their state Medicaid program, unable to get insurance from either one.

The inability to adjust coverage in tandem with changing life circumstances was becoming a major frustration for both consumers and enrollment specialists around the country who help people sign up through the health exchange.

Similarly, the computer system was not, until now, designed in a way that let people cancel insurance. In one instance, a couple enrolled for coverage in December, but the husband died before the health plan took effect on Jan. 1, according to an official familiar with the case, who said the widow has been unable to cancel her late husband’s part of the policy.

In other instances, federal officials have rethought some of the marketplace’s rules, as it has become clear that some of the customers who have used healthcare.gov purchased a health plan without fully understanding its benefits - or which doctors and other health-care practitioners were part of its network.

Specifically, the new policy says consumers may make changes before March 31, the end of an open enrollment period that began in October, if they want to “move to a plan with a more inclusive provider network” or fit within “other isolated circumstances” according to the memorandum, which does not define what the other circumstances might be. People who switch must stay with the same insurer and the same tier of coverage.

Asked about the new rule, Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, the agency overseeing healthcare. gov, said, “We added this new flexibility, recognizing that many consumers are using a new system and getting coverage for the first time.” Officials had not decided when they were going to announce the change to the public.

According to the most recent federal figures, about 3 million Americans had signed up for health plans of late January through the federal marketplace operating in three dozen states and separate marketplaces in 14 states. It is unclear how many of those people have paid their first insurance premium - the step needed to become insured. Nor is it clear how many of the 3 million were uninsured.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation who specializes in consumer-assistance issues, said that most private insurance allows people to switch to any other health plans during open-enrollment periods, not just to other plans offered by the same insurer.

Under another element of the rules spelled out in the memorandum, consumers might be able, during open-enrollment periods this year and in the future, to switch from one insurer to another through a different means: refusing to pay the insurance premium so that the insurer cancels the policy. In that circumstance, the memorandum says, people can start over to apply for a plan.

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s main trade group, said, “Health plans want to make sure consumers are in health plans that meet their needs and they’re happy with.”

Meanwhile, federal officials said Friday that another wrinkle in the healthcare.gov website - one that temporarily left some children without insurance coverage - has been fixed.

Children who have been denied Medicaid coverage can now be added to a subsidized plan, the Centers for Medicare and Medicaid Services said in a letter to a New Hampshire congressman.

U.S. Rep. Carol Shea-Porter wrote to the agency after a report by The Associated Press revealed the glitch last month.

Children who qualify for Medicaid cannot be covered under subsidized family plans purchased through the federal online markets. That left some without coverage until their Medicaid eligibility was determined, while others who were rejected for Medicaid still couldn’t be added to their parents’ plans.

In a letter to Shea-Porter on Friday, the agency said consumers can now use the website to report if someone was denied coverage and take steps to add the child to a subsidized plan.

Information for this article was contributed by Amy Goldstein of The Washington Post and by staff members of The Associated Press.

Front Section, Pages 1 on 02/08/2014

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