HHS sees the train-wreck coming and now wants insurers to enroll people retroactively

Written by . Posted in 2014 Campaigns, Issue Watch, Yep, This Happened

Published on December 12, 2013

CaptureObamacare — it’s so well designed that they have to keep changing it on the fly to prevent the next disaster.

As the Washington Examiner’s Philip Klein notes, HHS is now trying to offload at least some of the blame for the coming chaos as applicants and insurers try to figure out who is actually enrolled and who isn’t as the new year begins. 

The agency is requiring premium payments to be accepted right up to the last minute, and requesting that insurers retroactively enroll people who pay late, even into the middle of January. It’s also “strongly encouraging” them to add doctors to their networks, at least in order to treat the most extreme cases. It’s a tacit admission that the law is setting up a lot of people to lose the care they were depending on.

If they’re doing this, they must expect this thing to be pretty bad. Conveniently, some of these new rules will complicate any effort to determine whether Obamacare has caused a net increase in the uninsured population as of January.

The following comes from an email from CMS that was forwarded straight from the Hill:

In an interim final rule issued today, HHS took the following steps:

· Requiring insurers to accept payment through December 31, 2013 for coverage beginning January 1, 2014

· Urging issuers to give consumers additional time to pay their first month’s premium and still have coverage beginning January 1, 2014

· Formalizing the previously announced decision giving individuals until December 23, 2013 to sign up for Marketplace health insurance coverage that would begin January 1

· Strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes or if the provider was listed in their plan’s provider directory as of the date of an enrollee’s enrollment
· Strongly encouraging insurers to refill prescriptions covered under previous plans during January.

Other ways the administration is working to provide consumers with a smooth transition to coverage include:
· Working with health insurers on options to smooth this transition, such as allowing people who come in after December 23 to get coverage starting January 1 or sooner than February 1;

· Working with insurers and consumers to make sure that they know whether their doctor or prescriptions are covered before they choose a plan, and how to get care they need during the transition (e.g., receiving a drug not covered by your plan if your doctor deems it medically necessary);

· Educating consumers who recently received cancellation notices about the possible option to extend their old policy or enroll in a new plan;

· Continuing outreach to consumers who began the application process through the Marketplace and experienced technical difficulties

To view the Interim Final Rule, visit: http://www.ofr.gov/OFRUpload/OFRData/2013-29918_PI.pdf