Say that again (it nothing but money and something we call rules and a process): Health Insurers Told to Ease Coverage Rules - Officials encouraging insurers to do something that normally would be anathema: offer coverage to consumers who sign up and pay a few days into the new year, but backdate the policies to Jan. 1.

From The Wall Street Journal:

The government on Thursday announced steps to stave off unpleasant surprises for Americans when the health-overhaul law fully kicks in Jan. 1, including measures to ensure continuous care for people with serious medical conditions.

The moves include a one-month extension of a federal insurance program for certain chronically ill people. The Obama administration also asked insurers to take a flexible approach about their rules when patients refill prescriptions or see their existing doctor in the early days of the new year in case new health plans haven't kicked in.

After fixing some of the problems that hobbled the federal HealthCare.gov site in October and November, officials now are turning their attention to 2014, when hundreds of thousands, if not millions, of people will flood the health system with new insurance.

 

Thursday's steps don't address all the possible complications. Some are aimed at ensuring that people enrolling at the last minute through the new health-insurance marketplaces can use their coverage immediately.

 

While consumers face a Dec. 23 deadline to sign up for coverage that will start Jan. 1, the administration said it was encouraging insurers to begin coverage in the new year even if applicants miss the deadline by a few days. Also, it said enrollees who pay their first month's premium by Dec. 31 have to be given coverage starting the next day. Insurers previously were allowed to set earlier payment deadlines.

 

Officials even encouraged insurers to do something that normally would be anathema: offer coverage to consumers who sign up and pay a few days into the new year, but backdate the policies to Jan. 1. It wasn't clear how many carriers would take up the idea.

 

The high-risk program was set up by the federal government under the health law as a temporary way to provide coverage for people who couldn't get insurance because of their medical history. The coverage was set to expire Dec. 31, on the assumption that beneficiaries would switch coverage to plans offered in the new exchanges. Starting in 2014, insurers will have to accept all customers and charge them the same prices regardless of their health, with limited variation based on age.

 

But some people in the program were worried they couldn't obtain a new plan in time and would see their treatment disrupted, owing to the problems with HealthCare.gov or other issues. The program will now stay open through January, paying out claims for about 85,000 existing enrollees from the remainder of a $5 billion fund set aside for it, the administration said.

 

For those who have private plans, the administration said it was calling on insurers to refill through January prescriptions covered under previous plans. It also said insurers should continue covering at standard rates patients' visits to doctors they had seen under their old policies, even if those doctors weren't part of a new plan's network.

 

The administration said it was "strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes."

 

The administration doesn't have the authority to force insurers to agree to the requests, but officials said Thursday they hoped carriers would do so.

 

Technological difficulties have beset the online exchange the federal government is running on behalf of 36 states, and those issues have stymied enrollment since the exchanges opened Oct. 1.

 

The administration said this week that it had started to see an uptick in enrollment, with some 137,204 people selecting a private insurance plan on the federal exchange through November, up from 26,794 in October. States running their own exchanges generally have fared better, with 227,478 people selecting plans through November, compared with 79,391 in October.

 

Collectively, though, the numbers fall well short of projections, and some early indications suggest that the people buying the new coverage are predominantly older. The state of California, one of 14 running its own health exchange, said Thursday that 35% of enrollees in private coverage are between 55 and 64.

 

Such numbers have sparked concerns about the balance of risk in the new marketplaces. Insurers are worried that problems signing up have meant that mainly sick people are the ones persisting long enough to get coverage.

 

Gary Cohen, an official charged with implementing the law, told an industry conference Thursday that the flurry of news reports about HealthCare.gov—even if they were negative—have brought the site to the attention of people who didn't know about it. "There is not a living, breathing American who hasn't heard now what the Affordable Care Act is and what the marketplaces are," he said.

 

Premiums for plans that are being sold for 2014 vary widely, suggesting a range of opinion among carriers about how risky the new population would be. Some of those expectations could be further upended by the unexpectedly rough start to the law.

 

Insurers will be looking to the first few months of 2014 to assess medical claims from their new enrollees, so they know how to set prices for plans for 2015 and beyond. The decision to extend the high-risk pools keeps people with costly medical conditions out of the new exchanges, which could skew the early claims data. That could make it more difficult for insurers to set prices for 2015.

 

The administration has already pushed back enrollment in the fall of 2014 by one month, saying it wanted to give carriers more time to assess data before they set rates.

 

Many states have their own high-risk pools for people whose medical conditions had made it hard to find insurance coverage. Some of them also have made plans to stay open past the end of 2013 because they were worried enrollees would be left without coverage.