By Kerry Young, CQ HealthBeat Associate Editor
December 12, 2013 -- The top U.S. health official has asked for a list of concessions from insurers to aid consumers trying to sign up for coverage through the new federal exchange—including making coverage retroactive if consumers miss deadlines.
The announcement aims to avoid gaps in coverage stemming from missteps in the startup of the healthcare.gov website.
One of the recently announced steps is to continue the Pre-Existing Condition Insurance Plan through January. It had been scheduled to end this month.
The steps announced by Health and Human Services Secretary Kathleen Sebelius in an interim final rule include formally requiring insurers to provide coverage beginning on January 1 if a person pays by Dec. 31. That takes away the companies' right to set earlier deadlines.
HHS also said that it was formalizing an earlier decision to move back the deadline for signing up through the marketplaces to Dec. 23 from an earlier cutoff date of Dec. 15.
But Sebelius also called on insurers to make other accommodations that would cover consumers if they miss these deadlines.
"We will consider moving this deadline to a later date should exceptional circumstances pose barriers to consumers enrolling on or before December 23," HHS said in a fact sheet. "This includes allowing issuers to offer retroactive coverage for people who sign up after Jan. 1. For example, if a person signs up and pays on January 5, they can have coverage with a start date of January 1," qualifying them for an advance premium tax credit, the fact sheet said.
Aetna Inc. already has agreed to allow people to make their first payments for coverage through exchange plans as late as Jan . 8 for coverage retroactive to Jan. 1, said Cynthia Michener, a company spokeswoman, in an e-mail. There was no immediate comment from America's Health Insurance Plans, the trade group for the industry. The office of the No. 2 House Republican, though, quickly offered up its assessment of the HHS announcement. "It's clear the administration knows Obamacare's problems are only going to get worse, and patients will be the ones who suffer," said Rory Cooper, a spokesman for Majority Leader Eric Cantor, R-Va. "What's not clear is whether they understand the confusion and chaos they continue to cause."
On a call with reporters, Sebelius said HHS is also urging insurance companies to make some voluntary concessions to ease the transition in the marketplace for consumers.
"We're encouraging insurers to allow consumers who pay portions of their premiums, such as a down payment, to be able to start their coverage on time," she said.
In addition, HHS said it was "strongly encouraging" insurance companies to treat out-of-network providers as in-network to ensure continuity of care for some services. It also wants insurers to treat out-of-network providers as in-network if they are listed incorrectly in a plan's provider directory as participating in the plan.
HHS also is "strongly encouraging insurers to refill prescriptions covered under previous plans during January."