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Deadline is today to buy health insurance for coverage Jan. 1

For anyone buying health insurance with an eye toward being covered by Jan. 1, the shopping deadline has arrived.

Today is the last day to buy insurance through the federal exchange for coverage Jan. 1, although people can buy exchange insurance through March to avoid federal tax penalties for not having insurance.

The initial Dec. 15 deadline was moved back to Dec. 23 by the federal government, which also last week declared that people whose individual insurance policies had been canceled by insurers (because they didn’t conform to the new Affordable Care Act standards for plans) will be exempted from the federal tax penalty for not having insurance next year. And they will be allowed to buy bare-bones, cheap plans.

This latest change in ACA requirements from the Obama administration prompted renewed criticism from House Majority Leader Rep. Eric Cantor, R–7th, never a fan of the law.

“Our entire health care system can’t be fundamentally changed at any given time subject to the random impulses of President Obama,” Cantor said in a statement. “How can anyone make health care decisions today knowing that the law may be unilaterally changed again tomorrow?”

For everyone else, the deadlines and mandates still apply.

Health insurers are scrambling to meet those deadlines themselves.

Doug Gray, executive director of the Virginia Association of Health Plans, pointed out that the Dec. 23 deadline leaves just about a week—and a week in which there’s a major holiday or two—for insurers to do the administrative work to cover new customers by Jan. 1.

That’s “a very short period of time to get someone enrolled and ready to go,” he said.

Most Virginia insurers, Gray said, have agreed to accept payment for those new plans through Jan. 14—so you could technically be covered Jan. 1 without having paid for it yet.

“I don’t think people understand how unusual that is,” Gray said.

National reports last week indicated that state-run insurance exchanges, which are separate from the federal one in which Virginia is participating, saw a surge in December enrollments.

There isn’t comparable December data from the federal exchange.

Gray said Virginia insurers did report seeing more activity in their exchange plans in December.

“I do know that in recent weeks, the reports are that the data that’s coming through are much better, and things are working more smoothly,” Gray said.

He noted that the Dec. 23 deadline is only for coverage that starts Jan. 1. Open enrollment runs through March.

If you’re still looking for exchange insurance coverage, it’s important to thoroughly check out the plan, what it covers, what the deductible is, and what doctors and hospitals are in-network for that plan.

In Fredericksburg, all three local hospitals—Mary Washington Hospital, Spotyslvania Regional Medical Center, and Stafford Hospital—are in network for the three companies offering insurance through the exchange, Anthem, Kaiser and Optima.

But in Anthem exchange plans, Mary Washington Hospital is considered “tier 2,” which means that you would pay more out of pocket for services there if you had Anthem’s exchange insurance.

That does not apply to Anthem’s plans that are sold off the exchange.

Anthem has a deal with HCA Virginia Health System for HCA’s network of hospitals to be the preferred providers for Anthem’s exchange plans. In the Fredericksburg area, that means Spotsylvania Regional, which is owned by HCA, is the preferred provider for Anthem’s exchange plans.

Stafford Hospital, which is owned by Mary Washington Healthcare, is considered tier 1 in Anthem’s exchange plans, which means the same network benefits apply there as at Spotsylvania.

A September news release announcing the ACA–Anthem exchange partnership said the deal would help keep costs lower in Anthem plans.

In that release, Spotsylvania Regional’s then-interim CEO Terika Richardson said HCA and the hospital had “enthusiastically entered into this partnership with Anthem to expand access to care across the Rappahannock region.”

In an email, Anthem spokesman Scott Golden said the company doesn’t discuss its contracts with hospitals.

Eric Fletcher, senior vice-president for marketing and communications at MWHC, said the tiered approach is “purely Anthem’s decision.”

Fletcher said that apart from that tier-2 designation for MWH itself in the Anthem exchange plans, all of MWHC’s facilities are contracted with the plans that can be bought on the exchange.

He also said the issue isn’t likely to affect that many people, because the tier-2 designation doesn’t apply to Anthem’s plans sold off the exchange. So for people who bought individual insurance from Anthem off the exchange or have Anthem coverage through their workplace, Mary Washington Hospital is in the network, as is Spotsylvania Regional and Stafford Hospital.

“The vast majority of people who have an Anthem or a Kaiser or an Optima plan have it through their employer, probably. Those plans are not impacted by this at all,” Fletcher said. “We might have four or five hundred people in our region who have signed up. So you’re literally talking about this impacting a couple of hundred people, maybe.”

Gray said that broadly, exchange plans sold in Virginia are not that different from the off-exchange individual plans sold by the same companies, except for the networks.

He said some companies have limited their exchange networks because the primary intent of the exchange plans is to provide insurance at a lower cost.

“The networks are definitely different in and out” of the exchange, Gray said, and the exchange plans are mostly HMOs.

“You can see some strategies to reduce premium cost inside the exchange,” he added. “The exchange atmosphere is created to try to get plans to compete on price. That’s what it’s for.”

Chelyen Davis: 540/368-5028



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