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grantcart

(53,061 posts)
Tue Oct 22, 2013, 02:36 PM Oct 2013

Widespread misunderstanding about ACA, clarifying Open Season & Enrollment numbers

It has become painful to watch the media talk about the ACA as the general misinformation about how insurance works is so widespread that most of the comments being made by the talking heads are incorrect.

Yesterday, for example, during the Andrea Mitchell hour (she was absent) there was a lengthy discussion about how problems with the ACA website may force them to extend the December 15 compliance deadline. Chris Cillizza went on how it was unlikely that the fixes would be in place by 12/15 and the law would have to be rewritten.

Except December 15 is not the compliance deadline for the individual mandate, the open season for the Marketplace enrollment is March 31, 2014. December 15 is the deadline in which you have to have paid the first month premium to get covered by 1/1/2014.

You are not 'enrolled' into an insurance plan until you pay for the first month's premium, if you want to use your insurance on Jan 1st you have to pay your premium on 12/15 or before.

Which brings us to this thread by Don Viejo:

http://www.democraticunderground.com/1014628209



Obama administration officials told the Associated Press that about 476,000 applications have been filed through the federal or state exchanges, but the White House remains cagey about actual enrollment figures.



I can give the AP the exact number of people who are 'enrolled', that is zero. After you choose your
plan then the insurance company contacts you and in time they send you a bill for the first month premium. People will start paying that bill in December. We won't have figures of people actually enrolled until January 1st, and then those numbers will have to come from the insurance companies not the Marketplace.

You can apply through the Marketplace but you cannot get enrolled, and the administration won't have those numbers, only the insurance companies will.

18 replies = new reply since forum marked as read
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Widespread misunderstanding about ACA, clarifying Open Season & Enrollment numbers (Original Post) grantcart Oct 2013 OP
But insurance companies may have estimated premiums based on a certain population buying in by Jan 1 dkf Oct 2013 #1
Cruz took one hell of a gamble NoOneMan Oct 2013 #3
If he wanted a Sarah Palin ball of fire type thing he achieved his aims. dkf Oct 2013 #8
"If they are bad they may discourage sign ups." BumRushDaShow Oct 2013 #4
No it's not against the law to not have insurance. dkf Oct 2013 #9
I have talked to about 2 dozen people at the store and walking around etc. grantcart Oct 2013 #6
Signing up isn't the end of it. dkf Oct 2013 #10
"it is reported" grantcart Oct 2013 #12
Yes, there is a huge backlog of people interested. Yo_Mama Oct 2013 #18
So? The reporting is wrong. The deadline isn't Dec. 15, no matter pnwmom Oct 2013 #11
K&R BumRushDaShow Oct 2013 #2
That's very short-sighted of them lame54 Oct 2013 #5
And you have to sign up for insurance by mid February to avoid the tax penalty... PoliticAverse Oct 2013 #7
No you have to be enrolled by March 31st. grantcart Oct 2013 #13
They announced yesterday they were changing the date for enrollment to March 31 to address the issue PoliticAverse Oct 2013 #14
There is no change, just misunderstanding the difference between applying and enrolling grantcart Oct 2013 #15
The reason for the March 31 deadline is the law provides for no penalty if you don't have PoliticAverse Oct 2013 #16
K & R Scurrilous Oct 2013 #17
 

dkf

(37,305 posts)
1. But insurance companies may have estimated premiums based on a certain population buying in by Jan 1
Tue Oct 22, 2013, 02:46 PM
Oct 2013

Late sign ups could affect the numbers and perhaps increase next years premiums.

Who knows if they estimated properly anyway.

So I am guessing that is more of a date insurers are interested in.

Another consideration, there will be real world examples of experiences using these plans. If they are good they could attract more people to sign up. If they are bad they may discourage sign ups. I have no idea which way this will go.

This is actually a risky thing to run your election on. Roll of the dice it seems to me.

 

NoOneMan

(4,795 posts)
3. Cruz took one hell of a gamble
Tue Oct 22, 2013, 02:50 PM
Oct 2013

Go hard or go home.

Today's horses ass might have street cred in two years if this turns to shit. Otherwise he is finished (and got an early 15, which most Republican candidates seem to get for a week or two)

 

dkf

(37,305 posts)
8. If he wanted a Sarah Palin ball of fire type thing he achieved his aims.
Tue Oct 22, 2013, 03:39 PM
Oct 2013

Who knows what his goal was.

BumRushDaShow

(129,085 posts)
4. "If they are bad they may discourage sign ups."
Tue Oct 22, 2013, 02:51 PM
Oct 2013

There is a minimum level of coverage required by the law. Having no insurance at all is what is "bad".

 

dkf

(37,305 posts)
9. No it's not against the law to not have insurance.
Tue Oct 22, 2013, 03:40 PM
Oct 2013

You just pay a fee, tax, penalty, whatever you want to call it.

grantcart

(53,061 posts)
6. I have talked to about 2 dozen people at the store and walking around etc.
Tue Oct 22, 2013, 03:02 PM
Oct 2013

None of them are political.

All of them had tried to get information on the site.

I am sure that once the problems get ironed out that the projections will be shown to be less than the actual sign up.
 

dkf

(37,305 posts)
10. Signing up isn't the end of it.
Tue Oct 22, 2013, 03:50 PM
Oct 2013

It's been reported that the calculator for the premiums had some bugs so the premiums might not be what the site claimed. Then there are reports that insurers are receiving incomplete or buggy data. Therefore people who think they are insured because they completed the website signup may not be. Also, getting insurance doesn't mean doctors accept you as a new patient. You need to find one who does. Lastly, everyone will find out how their insurance works after their visit and after billing. My last 2 doctors appts didn't have a bill at the time of service because they needed to look at my insurance coverage. I am still waiting to see what I owe.

grantcart

(53,061 posts)
12. "it is reported"
Tue Oct 22, 2013, 04:12 PM
Oct 2013

I know what is being reported by the insurance companies like AETNA that bitterly fought the plan from the beginning.

Color me skeptical.

I have received 4 timely letters from my insurance company and they confirmed exactly what was on the MarketPlace site.

There is a list of 300 doctors that take my insurance.

The insurance company I signed up with had the number 1 customer satisfaction in my area and client reviewers said they didn't face problems with billing. With no deductible and a 20% copay calculating my end shouldn't be a problem. I have always asked and received a comprehensive copay schedule with my insurances so I double check what the doctor's office bills.

Yo_Mama

(8,303 posts)
18. Yes, there is a huge backlog of people interested.
Thu Oct 24, 2013, 06:32 PM
Oct 2013

Obviously the currently uninsured and those with cancelled policies are the most active right now, but when things calm down a bit more will go hunting.

pnwmom

(108,980 posts)
11. So? The reporting is wrong. The deadline isn't Dec. 15, no matter
Tue Oct 22, 2013, 03:53 PM
Oct 2013

what the insurance companies "may have" done.

And the insurers know how many people are signing up with them. They don't need the government to tell them.

BumRushDaShow

(129,085 posts)
2. K&R
Tue Oct 22, 2013, 02:48 PM
Oct 2013

First thing that came to my mind with the bullshit about "applied" vs "enrolled" is that once you submit the form, it's up to the insurance company that you select to "enroll" you.

This is an example of the media narrative that is trying to insinuate that ACA insurance is government-owned and run and the constant bashing is designed to not only torpedo and topple Medicare (which is government-run) but any future efforts for single-payer.

grantcart

(53,061 posts)
13. No you have to be enrolled by March 31st.
Thu Oct 24, 2013, 01:55 PM
Oct 2013

From your article



You still have to be covered by March 31 to avoid the new penalties for remaining uninsured.


Now let me explain the confusion:

The industry standard is that you have to submit your first month premium on the 15th of the previous month for it to take effect on the first of the following month.

Typically in the past it has taken 30 days for a health insurance company to accept your application, that is why the Feb 15th day has come into effect.

Under the ACA you cannot be turned down so the application process now takes place when you submit your application.

In my case I received the billing information in about 10 days from the insurance company.

They indicate they are waiving the normal deadline of the 15th and quoting from my invoice:

"We have to get your initial premium payment of $ 444.79 by 01/01/2014." And you can pay by debit card over the phone.

So at least with my insurance company I could have waited until March to apply and made the initial payment on 3/31/14 and been covered April 1st.

It is also interesting to note, by the link in your OP, that it the penalty is calculated on a monthly basis. So a family with a combined income of $ 60,000 that was one month late would be charged $ 50.

Hopefully the website issues are quickly solved and the issue is moot.

PoliticAverse

(26,366 posts)
14. They announced yesterday they were changing the date for enrollment to March 31 to address the issue
Thu Oct 24, 2013, 02:13 PM
Oct 2013

discussed in the article I posted:

WASHINGTON -- The Obama administration will push back by six weeks the deadline for enrolling for health insurance without facing a penalty, a change officials say is intended to clarify a series of mismatched deadlines outlined in the law and not a response to problems with its insurance website.

Consumers will have until March 31 to sign up for insurance without paying a tax penalty in 2014, the White House announced late Wednesday. That date was already the end of open enrollment, but under the individual mandate rules it was not clear whether consumers who waited that long to enroll would still face penalties.

In announcing the change, officials cast the move as a clarification and not a reaction to the embarrassing glitches and technical problems with www.healthcare.gov, the website created to link the insured with affordable, private insurance plans.

Read more: http://www.latimes.com/nation/politics/politicsnow/la-pn-obamacare-insurance-deadline-delayed-20131024,0,6767960.story#axzz2ifFJ9LqW

grantcart

(53,061 posts)
15. There is no change, just misunderstanding the difference between applying and enrolling
Thu Oct 24, 2013, 02:26 PM
Oct 2013

which the LA writer continues to use interchangeably.

From your Boston Globe Article:



You still have to be covered by March 31 to avoid the new penalties for remaining uninsured. But to successfully accomplish that you have to send in your application by the middle of February. Coverage would then start Mar. 1.



From your LA article



Open enrollment, however, doesn’t end until the end of March, leaving an awkward gap. The new guidance makes clear that people who enroll by March 31 will not face the tax penalty.



Nothing has been rolled back or changed.

The previous "Feb 15 deadline" was based on pre ACA processes which required you to (quoting from the Globe article) "send in your application".

There is no more 'sending in your application'. You click on the link and your application is automatically sent and the insurance company has to accept you.

That doesn't mean that you are enrolled. You will still have to pay the first month premium, which as shown above with at least one company, can be executed on March 31st.

A lot of the confusion arises from the media using 'application' and 'enrolling' interchangeably.

The deadline has always been, and remains, March 31st to avoid any penalties. If someone misses it by a month then the penalty would be a maximum of .083%.



PoliticAverse

(26,366 posts)
16. The reason for the March 31 deadline is the law provides for no penalty if you don't have
Thu Oct 24, 2013, 04:18 PM
Oct 2013

a gap of coverage of more than 3 continuous months. If you missed the March 31 deadline for that by a month you'd owe
a penalty for 4 months not the 1 month your example implies.

Complete IRS rules on the penalty (with some example calculations at the end):
http://www.gpo.gov/fdsys/pkg/FR-2013-08-30/pdf/2013-21157.pdf

H. Short Coverage Gap

The proposed regulations provide that
an individual qualifies for the short
coverage gap exemption if the
continuous period without minimum
essential coverage is less than three full
calendar months and is the first short
coverage gap in the individual’s taxable
year. Further, in determining whether a
gap in coverage qualifies as a short
coverage gap, the length of the period
without minimum essential coverage is
measured by reference to calendar
months (for example, January or
February) in conjunction with the one
day rule in § 1.5000A–1(b). Therefore, if
an individual is enrolled in and entitled
to receive benefits under a plan
identified as minimum essential
coverage for one day in a calendar
month, the month is not included in the
continuous period when applying the
short coverage gap exemption.
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