Thu, Mar 06 2014
People who got off to a rough start with Obamacare or have yet to pick a plan still have options— but only if they move quickly before the open enrollment period ends on March 31.
Those who were unable to sign up for a marketplace plan because of the glitches with federal or state websites can receive retroactive coverage to the date they originally applied, as well as retroactive premium tax credits and cost-sharing subsidies, the federal government announced 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 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 federal guidance released in early February, 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 individual will generally be allowed to pick another plan at the same metal 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 metal level offered by the same insurer, according to the federal rules. However, changes due to provider network issues must be made by Mar. 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.