The federal government is promising that anyone who wants to buy subsidized insurance will be able to as long as they try to enroll before March 31. But insurers should expect more surprises and lingering work from complex cases.
In an operational update, senior HHS advisor Kurt DelBene said HealthCare.gov is hitting its stride with less than a week left in open enrollment, with nationwide exchange plan enrollment already surpassing six million, including state exchanges.
The website can now handle 100,000 users going through the application process at any one time, said DelBene, the former head of Microsoft's Office division who was brought in to help guide the struggling federal exchange in December.
On March 25, HealthCare.gov saw 1.2 million unique visitors and its call center took 390,000 inquiries.
That suggests a "surge" of consumers starting the process of buying insurance at the proverbial last minute, as federal health officials have been predicting these last six months -- especially among millennials.
What is not predictable, though, is just how many consumers will end up trying to buy plans in the last week, how many will be able to complete the process and how many will be left waiting "in line" and have to use the extended "special enrollment period."
The federal government is promising that anyone who starts the process prior to the stroke of midnight April 1 will be able to buy coverage. "Just like election day, if you are in line when the polls close, we'll make sure you get to vote," as Centers for Medicare & Medicaid Services communications director Julie Bataille put it.
"If many consumers come all at once" to the website this week, they'll be put in a queue in a "virtual waiting room," or they can leave an email and come back later after the March 31 deadline and "attest that they were in line and unable to complete their enrollment."
It's not clear, though, how or if CMS will enforce that requirement, or if there will be a penalty.
"Attestation is added to the existing information that is already on the application," Bataille said. As for wrapping up the special enrollment period, "It could take a few days, it could take a week or so," she said.
Consumers submitting paper applications or who had documentation issues pending on March 31 will have until April 30 to select a plan, and like those who enrolled after March 15, will have coverage effective May 1, CMS explained in new regulatory guidance.
"Issuers will receive direction to effectuate accelerated effective dates for this group of consumers through the Health Insurance Casework System," CMS regulators wrote.
More work for health plans
In addition to those waiting in line, there are also 10 categories of individuals who will qualify for special extended enrollment, including people affected by exceptional circumstances like a natural disaster, "system errors related to immigration status," "display errors" on HealthCare.gov and "other system errors, as determined by CMS, which hindered enrollment completion."
All of which means insurers can expect to be doing a lot of work in April and even into May processing, confirming and reaching out to new enrollees -- as well as getting payments from them and the government and starting to learn about their health needs.
And insurers selling in a number of state exchanges can also expect to deal with last minute enrollment fixes.
Exchanges in Maryland, Massachusetts, Nevada, Oregon, Vermont and Washington State are giving consumers extra time through a range of options, all except Oregon offering a variation of the federal "in line" policy.
With permission from HHS, Oregonians will be able to apply through Cover Oregon up until April 30 and finalize their applications and choose plans into May.
Those consumers who buy plans through Cover Oregon will avoid the individual mandate penalty, but Oregonians who buy plans outside the exchange after March 31 may have to pay a partial penalty, according to a deal worked out between Oregon Governor John Kitzhaber and HHS Secretary Kathleen Sebelius.