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Government relaxes health insurance deadlines again

You can have Jan. 1 coverage if you pay by Dec. 31

Published: December 12, 2013 05:15 PM

The federal government on Thursday said it’s cutting some slack for the many Americans who have been sweating getting new health coverage in place by Jan. 1. Among the several measures announced by the Department of Health and Human Services are deadline extensions for enrolling or paying for new coverage and steps to make sure people with serious ongoing health conditions have enough time to transition to new plans.

To quickly review where things have stood up until now: in order to have health coverage that starts on Jan 1, consumers have been given until Dec. 23 to enroll in a plan. When payment was due has been left up to insurance companies to determine.

Here are the updates announced today:

Extra time to enroll and/or pay for a new plan

HHS now says that if you pay your first month’s premium by Dec. 31, insurers must start your coverage on Jan. 1. The government is also “encouraging” insurers to allow coverage retroactive to Jan. 1 to customers who sign up and/or pay early in January.

Our advice: It’s still in your best interest to enroll and pay your first month’s premium as soon as you can, preferably by that Dec. 23 date. We agree with HHS’s advice to check directly with the carrier to make sure it’s received your payment.

A one-month grace period for doctors and prescriptions

HHS is “strongly encouraging” insurers to allow new enrollees to continue with their old doctors and prescriptions during January, and to charge them in-network prices even if the drugs and prescriptions are not in the new plan’s provider network or on its list of preferred drugs.

Our advice: If you have providers or prescriptions that you want to keep, this option should be your second choice. Your first choice should be to select a new plan that includes them in its network. To that end, you can take advantage of another new requirement announced today, which is that insurance companies must provide accurate and up-to-date lists of network providers and drug formularies that consumers can consult when shopping for a new plan.

A one-month extension of a special plan for people with serious health conditions

Since shortly after the health law was passed in 2010, every state has had a Pre-Existing Condition Insurance Plan (PCIP) that offered coverage at commercial rates to people with serious medical conditions who were turned down by private companies. These plans were closed to new enrollees earlier this year when the $5 billion appropriated to fund them started to run out, and the plans were scheduled to terminate at year’s end. There are still about 86,000 people on these plans nationwide, according to Chiquita Brooks-Lasure, deputy director of HHS’s Center for Consumer Information an Insurance Oversight. HHS will now allow PCIP enrollees to stay in their plans through the end of January, to give them plenty of time to find new plans that adequately cover their often-severe health conditions.

Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can't get enough health insurance news here, follow me on Twitter @NancyMetcalf.

Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper, below.

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