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As health site woes continue, officials extend high-risk plan and payment deadlines

The Obama administration on Thursday announced a series of changes designed to buy people time as they try to gain coverage through the troubled health insurance exchange.

Among the measures is a one-month extension of a federal insurance plan for people with serious health conditions such as cancer. That pre-existing condition program, created under the Affordable Care Act, was originally due to expire on Dec. 31, but many people haven't been able to secure new coverage that would begin Jan. 1.

The news comes as yet another problem emerges involving HealthCare.gov: Subsidy determination errors that could mean months-long delays in getting coverage.

For example, Pat Chevalier, a 62-year-old St. Petersburg retiree, was told she doesn't qualify for a subsidy even though her $18,000 annual income should make her eligible for significant financial help paying her premiums.

"I was in shock," she said, explaining she was told her only alternative was filing an appeal that could take 90 days.

Thursday's announcement highlights the administration's awareness that many people are struggling to get coverage. The new measures also will place additional demands on private insurers, who already say they were struggling to cope with previous deadline extensions. In addition to extending the pre-existing conditions plan, the new steps include:

• Giving other consumers who want their new coverage to start Jan. 1 an additional eight days — until Dec. 31 — to pay their first premium.

• Considering an extension of the Dec. 23 enrollment deadline for certain "exceptional circumstances."

• Requesting that insurers let people who sign up after Dec. 23 still get coverage starting Jan. 1

• Encouraging insurers to refill prescriptions during January that were covered under previous plans so consumers don't face gaps in their medications.

"We are committed to meeting consumers where they are in the health coverage process, helping them access and shop for quality, affordable insurance," the U.S. Health and Human Services said in a statement Thursday.

Although the HealthCare.gov site has been functioning better from the consumer side, there have been numerous reports of "back-end'' problems, including inaccurate reporting to insurance companies. This means that although some consumers may think they have signed up for coverage, their new insurer may not know about them.

HealthCare.gov also connects consumers with Medicaid, the state/federal insurance program for the poor. And now there appears to be a new source of confusion: Consumers like Chevalier who go to HealthCare.gov seeking subsidized private insurance are being incorrectly deemed eligible for Medicaid.

If that happens, they can't get subsidies — nor can they get Medicaid. Appealing that determination can take up to 90 days, making Jan. 1 coverage impossible.

Chevalier's $18,000 income should qualify her for substantial premium subsidies — more than $6,100 a year, according to the Kaiser Family Foundation's online calculator.

However, she said, the federal call center told her she was below the poverty level, and therefore ineligible for subsidies. But Florida did not expand its Medicaid program, call center operators told her, so she is out of luck.

In reality, her income is several thousand dollars above poverty guidelines. But because the system had already made the determination, Chevalier's only recourse is a lengthy appeal.

Asked about Chevalier's case, an HHS spokesman declined to provide an on-the-record explanation.

Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, said she has heard of numerous consumers who should qualify for subsidies but are wrongly labeled Medicaid eligible.

In one case, she said, a family of four with a nearly $80,000 income was told they qualified for Medicaid. In another case, a single man who made $38,000 was declared Medicaid eligible. Now they must appeal if they want to get subsidies to help them purchase a plan.

"They can't clear it out even though it's something that's so obviously a mistake," said Waltman.

Matt Salo, executive director of the National Association of State Medicaid Directors, said he also has heard of people being wrongly steered toward Medicaid.

But it's impossible to quantify the problem, he noted, because the federal government has had problems transferring the potential Medicaid accounts to the state Medicaid offices.

"At this point, there's literally no way for us to tell whether it's anecdotal or systemic," he said.

Among those who need answers are Bruce and Michele Scheid of Spring Hill. Bruce has Medicare, but Michele, 58, was hoping to get a subsidized plan. Their income last year was $40,000 — making them eligible for a $3,000 subsidy, according to the Kaiser calculator.

But the federal call center told them they didn't qualify.

Michele has a limited benefits plan that she wanted to trade in for comprehensive coverage. "We're both a little upset because we were hopeful of improving on what we have now," he said.

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

As health site woes continue, officials extend high-risk plan and payment deadlines 12/12/13 [Last modified: Thursday, December 12, 2013 11:04pm]
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