The Daily Item, Sunbury, PA

January 5, 2014

Coverage not just a click away

Paperwork needs to be checked, premium paid

By Rick Dandes
The Daily Item

DANVILLE — DANVILLE — For those able to successfully navigate the HealthCare.gov website, there’s still work to be done to ensure that success online leads to actual coverage, now that we’re in the New Year and, said an official at Geisinger Health Plan, in Danville.

“Things have been changing by the day, it seems,” said Amy Bowen, a Geisinger spokeswoman. “Right up until the deadline, midnight Christmas Day, we were being informed of changes to Obamacare. A lot has happened at the eleventh hour.”

For one thing, the first day to sign up for January coverage was Dec. 21. Then it was changed to Dec. 24. “You could enroll, but the real effect of Obamacare didn’t kick in until the client pays,” Bowen said.

The changes made by the Affordable Care Act took 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, users should 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,” he added. “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 HealthCare.gov 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.

Bowen explained that most people must have health coverage in 2014 or pay a fee.

If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1 percent of your income (whichever is higher).

The fee increases every year.

“Some people may qualify for an exemption to this fee,” she noted.

If you enroll by March 31, 2014, you won’t have to pay the fee for any month before your coverage began, Bowen said.

Marketplace open enrollment for 2014 ends March 31, 2014.  

That is the real significant deadline.

Open enrollment for 2015 is from November 15, 2014 to January 15, 2015.