Sebelius 'Urging' Insurers to Cover People Who Haven't Paid

December 13, 2013 - 10:09 AM

sebelius

Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill on Wednesday, Dec. 11, 2013, before the House Energy and Commerce Committee hearing on the implementation failures of the Affordable Care Act. (AP Photo/Susan Walsh)

(CNSNews.com) - Fearing that many people will think they have health insurance coverage when they do not, Health and Human Services Secretary Kathleen Sebelius is "urging" insurance companies to "give consumers additional time to pay their first month's premium and still have coverage beginning Jan. 1, 2014."

Insurance companies should cover people who haven't yet paid, in other words.

With just a few weeks to go until Obamacare takes full effect, Sebelius announced additional changes on Thursday, some that tell insurance companies how to run their business and others that "strongly" encourage insurance companies to waive their rules -- on premium payments, for example.

Sebelius now says insurance companies MUST accept payments through December 31 (instead of Dec. 23) for health care coverage that begins the next day, Jan. 1.

She also is "urging" insurance companies to "give consumers additional time to pay their first month's premium and still have coverage beginning Jan. 1, 2014."

That's because many people who have "enrolled" in Obamacare have not yet paid their premiums, which is supposed to happen for coverage to begin.

Other steps announced on Thursday:

-- People enrolled in the federal Pre-existing Condition Insurance Plan will be allowed to extend their coverage through Jan. 31, 2014 if they haven't selected a new plan on the exchanges. According to HHS, "The additional month gives this vulnerable population additional time to enroll in a plan and ensure continuity of coverage."

-- HHS is "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."

-- HHS is "strongly encouraging insurers to refill prescriptions covered under previous plans during January."

“We are providing additional flexibility to consumers across the country to ensure they have access to coverage options that begin on January 1, 2014,” said Secretary Sebelius.  “The Department is committed to providing consumers with the information they need to pick the coverage option that works for them and their families.”

And more changes may be coming: The administration says it is trying to "smooth this transition" by:

-- Working with health insurers on options such as allowing people who sign up after December 23 to get coverage starting January 1, or sooner than February 1;

-- Working with insurers and consumers to make sure 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 (if the insurer agrees) or enroll in a new plan;

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

"HHS is committed to meeting consumers where they are in the health coverage process, helping them access and shop for quality, affordable insurance," Sebelius said.

The insurance industry says additional changes so close to the enrollment deadline are not helpful:

“With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process,"  said Karen Ignagni, president and CEO of Americas Health Insurance Plans (AHIP).

"Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with healthcare.gov.”

In her testimony before a House panel on Wednesday, Sebelius acknowledged that "a lot of people" haven't paid their premiums, which go directly to the insurer.

She also said people who shop for insurance on the exchanges must pay their premiums to be covered.

The rules and encouragement announced by HHS on Thursday suggest the administration also realizes that the problems with Obamacare go well beyond a dysfunctional website to the coverage itself.