Obamacare Enrollees Could be Missing a Crucial Step to Get Coverage

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Out of the 14 states that built their own Obamacare websites, Massachusetts is one of three states unable to do reliable online enrollments. The troubled website in Massachusetts led the state to stop paying the main contractor, CGI, which was also the largest contractor for the failed, original version of HealthCare.gov. Wyatt Andrews reports.

More than 1.1 million Americans have signed up for health insurance since the new marketplace’s rocky rollout in October, just in time for their coverage to kick in on Jan. 1. But a significant number of enrollees might be in for a rude awakening come the new year.

According to the Kaiser Family Foundation, many consumers have yet to complete a crucial step in the enrollment process that could delay their coverage — paying their first month’s premium. 

“There have been anecdotal reports of a large percentage of people not [paying for their premiums],” said Larry Levitt, co-director of Kaiser’s Program for the Study of Health Reform. “But we’re certainly getting to the point now where it will be important for people to make those payments in order to be covered.”

There are a few reasons why people might have skipped this final step, not least of which has been the instability of the health care marketplace itself. And of course, good old-fashioned procrastination is no doubt at play as well.

“No one wants to pay for something that doesn’t start for a while,” Levitt said.

Also, once they select a plan through the marketplace and receive a congratulatory enrollment email, it can be easy for consumers to simply assume that their work is done. 

That’s far from the case. Here’s what you need to know to be sure your coverage is complete.

Mind the shifting deadlines.

You signed up for a plan before the Dec. 25 deadline — you’re all set, right? Not exactly. Until you’ve paid your first month’s premium, you’re not finished yet.

If you enrolled in a plan by Dec. 25, you have until Jan. 10 to make your first payment for coverage to take effect on Jan. 1.

Once your payment is complete, it can take anywhere from two to three weeks before you receive an insurance card in the mail. To be on the safe side, we’d recommend delaying any non-urgent medical treatment until you’ve either received your card or called your insurer to confirm successful payment. If your insurance hasn’t gone through yet, you may have to pay the full cost of the visit. But you may still be able file a claim to get reimbursed for treatment given after Jan. 1, so long as your insurer agrees to cover treatments retroactively; just note that it could take a few weeks until you see a check.

Check your marketplace profile.

Whether you signed up through the federally-run marketplace, Healthcare.gov., or through your state’s marketplace, you can log onto your account and check to see that your enrollment application was successfully processed.

You should have received an email confirmation as well, so be sure it didn’t get chucked into your spam folder. After you’ve confirmed enrollment, wait to hear from your insurer about making your first payment.

Once you’ve successfully applied for coverage through the state or federal marketplace, your insurer is now your go-to contact for any questions regarding your account. The insurer should send you an email or letter in the mail laying out the next steps for enrollment. It shouldn’t take more than two weeks, but delays are not uncommon.

A Healthcare.gov representative we spoke with said some third-party insurers, especially dental insurers, have had issues dealing with the volume of applicants since the new marketplace launched, leaving many consumers in limbo while they work through the backlog.

Still no email or letter from your insurer? Call them up. 

Give your insurer a call to check on the delay. Chances are they will blame the lag in service on high demand, but at the very least you will know that your application hasn’t vanished.

If you hit a dead-end, you can reach out to the health care marketplace hotline for assistance (1-800-318-2596).

Make your payment and wait for a confirmation email.

If you’ve received information from your insurer and are ready to make your first payment, it’s simple enough. Either pay by phone or by calling their customer service line, or deposit your payment online if electronic billing is available.

You’ll get an email confirmation and should then be able to log onto your insurer’s website to access your coverage and check your benefits. Within a few weeks, a packet with your insurance card and full benefit information should arrive in the mail. We’d recommend playing it safe and hold off on setting up any doctors’ appointments until you’ve gotten your membership card or can confirm that your doctor’s office has a record of your insurance.

Each insurer will dictate their own deadline for your first payment. Don’t assume they’ll cover you beginning on Jan. 1. Instead, contact them directly to see what your options are, including whether they’ll agree to retroactively cover treatments you received before making your first premium payment.

Still not sure you're covered?

If you haven’t gotten your benefits package and are still unsure that your payment was processed correctly, you can do a couple of quick tests: First, check that the money was withdrawn from your bank account or charged to your credit card. Second, call your insurer to verify that their record shows payment. If both of these tests check out, then you have done everything right and all that’s left is to do is wait and see.

However, if there’s no withdrawal from your account within a week or so, it’s probably time to give your insurer another call. Open enrollment ends March 31, so there is luckily still time to sort things out.

It can be a frustratingly mind-numbing process, but once you’ve made it past the hurdle of the marketplace itself, remember that the ball is still in your court.

“People are not actually insured until they pay their premium,” Levitt says. “Until they get a notice from their insurer telling them that their premium is due and they actually pay it.”

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