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With Three Weeks Left, Consumers Fear They May End Up Without Health Coverage On New Year’s Day


Prompt Enrollment Threatened

Within the Obama administration, concern is great enough about accommodating everyone who wants coverage by the first of the year that officials pushed back the deadline from its original date of Dec. 15. 

Prompt enrollment is urgent for people in several circumstances. Some have no coverage, either because they haven’t been able to afford it or, like Momi, because they have pre-existing medical issues that led insurers to reject them in the past. Some have insurance that is going to expire. That group includes people whose health plans have been canceled and those in a high-risk pool that is closing. For people with serious medical issues, such as cancer patients in the middle of treatment, the loss of coverage could be medically and financially devastating.

Sara Collins, a vice president at the Commonwealth Fund, a New York health care foundation, predicts two waves of people will try to sign up for plans in the first half of December: those who had tried to shop on the websites but were stymied by technological glitches and those who were able to look at plans but didn’t settle on one.

For those who wait until the Dec. 23 deadline -- either by choice or because they encountered difficulties—insurers will have just a week to process the applications before people can start filing claims. Robert Laszewski, an insurance industry consultant, says insurers generally need two weeks to add newly covered people into their computer systems. "The chances are we're going to see lots of customer service problems," he says.

'Nobody Knows What Accident They Can Be In'

Sandra Fox, a psychiatric social worker in Pittsburgh, has been trying to buy insurance through the marketplace since the day it opened at the beginning of October. After many failed attempts to get on, she succeeded. But the website said she and her husband, an artist, are not eligible for a government subsidy while she believes they are. (Based on information she provided, KHN calculated they are eligible for a $292 monthly subsidy.)  She was told to mail a written appeal, but despite sending it off Nov. 1, her case remains unresolved.

Fox's husband goes to a pain clinic and uses medication for his spinal stenosis. She fears if they are not enrolled in new insurance when their current policy lapses at the end of the year, they will have to pay out-of-pocket.  "It would be extremely expensive," she says. "And nobody knows what accident they can be in tomorrow. I don't think it's wise to be without insurance for one day, frankly."

Early mix-ups occurred in the launch of the last major federal health expansion, the Medicare Part D prescription drug benefit. People were supposed to sign up by Dec. 31, 2005, to start using the benefit when coverage began on Jan. 1, 2006. But that turned out to not leave enough time for Medicare to process all the enrollments.  "There were all these stories about people showing up to pharmacies and the pharmacies not having the seniors in the systems," said Sabrina Corlette, who directs the Health Policy Institute at Georgetown University. "And the seniors walked away empty handed because Medicare hadn’t transferred the information."

Wed, Nov 27 2013

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