20 percent of Wisconsin ACA enrollees have not paid first month’s premium

Insurers on the federal health insurance marketplace did not receive payment for 20 percent of plans with Jan. 1 and Feb. 1 effective dates, according to the State of Wisconsin and the Wisconsin Office of the Commissioner of Insurance.

OCI and the State issued a press release last Friday encouraging consumers to double check the status of their health insurance. The release included an “FAQ” on federal health care law enrollment that provides recent figures on premium payments for insurance plans purchased on the federal marketplace.

According to this data:

  • “Total federal exchange enrollment into plans with a Jan. 1 effective date: 34,329. Insurers received premium for 28,178 of these plans (unpaid 18 percent).
  • Total federal exchange enrollment into plans with a Feb. 1 effective date: 12,733. Insurers received premium for 9,604 of these plans (unpaid 25 percent).
  • Total federal exchange enrollment into plans with Jan. 1 and Feb. 1 effective dates: 47,062. Insurers received premium for 37,782 of these plans (unpaid 20 percent).”

The “FAQ” says that if a consumer has enrolled and has not paid their premium, they should first contact the insurer.

Additionally, it says “If the consumer has not paid January’s premium by now, they will not have coverage for January, even if they try to pay their premium. Health insurance purchases historically are always paid in advance of the month of coverage. Many insurers did make exceptions throughout January but in most cases insurers do not accept late premium payments due to adverse selection problems (for example people who only pay when their claims exceed their premium). If the consumer has no coverage, they should sign up for a new plan as soon as possible.”

In its release, OCI said the problems with the federal website, HealthCare.gov, are “not fully over.”

“The best thing any consumer can do is be proactive,” stated Insurance Commissioner Ted Nickel. “You’ve shopped around to purchase the best plan for you. Now you should take the next step to verify your coverage. Protecting you and your family’s health is paramount.”
Commissioner Nickel recommends the following steps:

  • If you haven’t received your enrollment materials within the expected time frame, check with your agent or the insurer to make sure you have coverage.
  • Check to make sure that you have received enrollment materials.
  • Verify that you have actually paid for coverage. For example, if paying by automatic withdrawal, check to see that the insurance company has debited your account for the premium you expected.
  • Read your policy documents and make sure your deductibles and copays match what you were expecting. Make sure your medical providers are in the insurer’s network.
  • If you see any discrepancies, immediately contact your insurer.

“We are here to help,” continued Nickel. “We have worked with insurers to make sure all consumers are being treated fairly. If you don’t feel you are being treated fairly, contact our office and we’ll see what we can do to help.”

March 15 was the final date to enroll to be insured by April 1, said Dan Schwartzer, deputy commissioner of insurance. All people looking to sign up for an individual plan still can do so by March 31, but that coverage won’t be effective until May 1.

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