Changes designed to make it easier for consumers to buy insurance through the health insurance exchanges address some concerns raised by physicians.
In a rule issued Dec. 12, the Health and Human Services department formalized a requirement that insurers give consumers until Dec. 23 to choose a health insurance plan and until midnight Dec. 31 to pay for it, in order to be considered covered on Jan. 1. State exchanges can set their own rules about Jan. 1 coverage dates, and in some cases, already have, Chiquita Brooks-Lasure, policy director for the HHS center for consumer information and insurance oversight, said during a press briefing.
Some states may elect to allow payment later than Dec. 31, she said. The HHS is asking insurers to consider accepting payment after Jan. 1 and retroactively cover services. Ms. Brooks-Lasure said that Aetna has already said it will accept payment until Jan. 8.
Insurers are also being asked to accept partial payment for the first month’s premium. Payment flexibility "will reduce the risk that patients will start the year without coverage," said Bob Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.
Dr. Bob Doherty
The agency is also "strongly encouraging" insurers to consider out-of-network providers as in network and to pay for prescription refills even if the drug is not covered under its plan – at least for the month of January.
The request has precedents, Michael Hash, director of the HHS office of health reform, said during the briefing. "This transition opportunity is quite common in the insurance world."
Mr. Doherty said the ACP hopes that "the insurance industry does its part to help ease the transition, especially by allowing patients who are in a course of treatment to keep seeing their doctors even when they are not in the plan’s network and to continue to get the drugs prescribed for them if not on the plan’s formulary."
Physician groups have asked that such a transition period be considered. At a White House meeting on Nov. 26, they expressed concern that patients in the midst of expensive or specialized treatment might experience a major disruption in care if forced to give up a particular physician or therapy when switching to a new plan.
Mr. Hash said insurers were open to accommodating new enrollees. He said the HHS and insurance companies are working together to "make sure that everyone seeking coverage effective Jan. 1 gets coverage."
The HHS also announced on Dec. 12 that the almost 86,000 individuals in the federal high-risk pool, known as the Pre-Existing Condition Insurance Plan (PCIP), have had their coverage extended to Jan. 31. Those policies had been set to expire Dec. 31.
The program has had its share of financial troubles, and in February, the HHS temporarily stopped enrolling new patients. House Republicans charged that the PCIP had been mismanaged and sought to give it more money. That never happened. On the call with reporters, Ms. Brooks Lasure said the program had spent only $4.74 billion of the $5 billion allotted to it under the Affordable Care Act (ACA), and thus, could afford to pay for the additional month.
The American Cancer Society Cancer Action Network (ACSCAN) applauded the PCIP extension. "Extending coverage under PCIP gives patients valuable additional time to select the marketplace plan that best meets their unique needs," ACSCAN president Chris Hansen said in a statement.
House Republicans, however, portrayed the PCIP policy change as "another delay" in ACA implementation. "The administration has known for many months that this law was not ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement.
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