Coverage expansions, new deadlines mark race to ACA enrollment


Improvising is becoming a critical skill for insurers as Americans race to the plan enrollment finish line: The government wants payers to offer temporary in-network coverage for out-of-network doctors and drugs, and some insurers may extend premium payment due dates to enroll new customers.

The government is "strongly encouraging" insurers to treat out-of-network providers as in-network to maintain care continuity for people experiencing acute episodes and for those who assumed their doctors participated based on network directory listings available at enrollment, the U.S. Department of Health & Human Services announced yesterday. Further, HHS wants insurers to allow payment in January for prescription refills covered under prior plans.       

The intent is to ease transitions to new plans by providing "additional flexibility to customers across the country to ensure they have access to coverage options that begin on January 1, 2014," said HHS Secretary Kathleen Sebelius in the announcement.

After getting complaints about erroneous provider directories, HHS is requiring payers to make accurate, current provider lists and drug formularies available to customers before they buy exchange plans, MedPage Today reported.

America's Health Insurance Plans expressed concern about the new regulatory guidance. "With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process," AHIP President Karen Ignani said in a statement yesterday.      

In yet another reform-related deadline extension, some insurers and state exchanges are giving Americans extra time to pay their first monthly premiums for Affordable Care Act coverage, Reuters noted. While this grace period may help payers determine who signed up for what, it also slashes the time available to verify enrollment and distribute identification cards and welcome packages, the article noted.  

In Oregon, a backlog on the state exchange is threatening the Jan. 1 enrollment of over 30,000 customers, reported OregonLive. Though some insurers agreed to delay the deadline for accepting enrollment information from Cover Oregon, not all payers are willing or able to do likewise. This has prompted Oregonians to enroll in off-exchange plans to meet the individual mandate.

For more:
- read the HHS announcement
- see the MedPage Today article
- here's the AHIP statement
- check out the Reuters article
- read the OregonLive article

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