What to do if HealthCare.gov messed up your application

You may qualify for a Special Enrollment Period

Published: May 15, 2014 02:45 PM

Q. My aunt tried to get health insurance through Obamacare and was told by a broker she wasn’t eligible because she didn’t have a credit record. She has always lived frugally and never took on any debt. Why would the health reform law deny coverage to people just because they don’t have a credit score?

A. Your aunt was done a huge disservice by the broker. She was fully eligible to buy insurance through her state’s exchange and should never have been told otherwise.

That’s the bad news. The good news is that even though open enrollment is over, people like her, who tried to enroll but were stopped by wrong information, computer problems, or other things beyond their control, are eligible for a Special Enrollment Period so they can get insurance right away instead of waiting until next year.

Your aunt fell afoul of a complicated process called “identity proofing,” meant to verify the applicant’s identity. When a person started an application, the health insurance marketplace would send an electronic query to Experian, one of the three big national credit reporting agencies. Experian’s computers would look up the person’s credit history and generate a series of questions that a real applicant would know the answer to but an impostor wouldn’t. It might ask the person to identify which of four addresses he or she used to live at, or the make of a car purchased with a loan.

But people like your aunt don’t have an Experian credit history to look up, said Sonal Ambegaokar, a senior attorney with the National Health Law Program, a nonprofit advocacy group, including “people coming out of foster care, recent immigrants, low-income people, older people who’ve never used credit, and recent graduates who don’t have a credit history yet.”

The absence of an Experian record stopped the application process cold—but, as the broker should have known—the marketplace provided an alternative means of ID proofing. Applicants  were supposed to be told to call the “Experian help desk” and receive instructions on how to mail in or upload identity documents. Once Experian verified them, it was supposed to notify the applicant within 7 to 10 days that he or she could continue on to enroll in a plan.

That didn’t always happen, it turns out. “ID proofing was not very well explained,” Ambegaokar said. “Applicants were told, 'We can’t verify your identity so we can’t proceed,' with no explanation of what the process was or what their other options were.”

Many people wrote me to say they had sent their documents in and were still waiting to hear back weeks or even months later. The government says that some sent in the documents without enough information to enable Experian to match it with their marketplace account.

While ID proofing was a major problem, it wasn’t the only one, Ambegaokar says. Many immigrants were unable to get the marketplace’s computers to verify their visa or green card, even though all their documents were fully in order—another glitch that stopped the application process cold.

If you have experienced any of these problems, here’s what to do.

“The service representative can go online and see where you got stuck in your application,” Ambegaokar said. “At that point, they have the authority to grant you a Special Enrollment Period.”

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.

—Nancy Metcalf


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