The clock is ticking on health care coverage. If you’re one of about 48 million Americans – roughly 7 million in California – who don’t have health insurance, you’ve got until March 31 to sign up.
That’s the deadline for all Americans to sign up for new, expanded health care benefits under the federal Affordable Care Act.
With the deadline just three weeks away, the state’s health care exchange – Covered California – is predicting there’ll be a “strong” sprint to the March 31 finish line. Those who ignore, forget or opt to not buy health insurance by the deadline could face tax penalties of $95 per person.
“We encourage everyone: If you haven’t started shopping, do so as soon as possible. You don’t have to wait until March 31,” said Roy Kennedy, Covered California spokesman.
As of mid-February, the latest reporting period, more than 828,600 Californians had signed up for new policies, according to Covered California. Of those, the vast majority – roughly 86 percent – were eligible for federal subsidies, which reduce the cost of monthly premiums. Kennedy said the sign-ups thus far had “exceeded our expectations and projections. We didn’t expect to get every uninsured Californian enrolled the first year. It’s a long-term plan.”
Snafus and confusion
Both in California and nationally, the websites that enable consumers to sign up for Affordable Care Act policies have been plagued by glitches that have slowed – and in some cases, shut down – the sites.
Consumers have also complained about long delays both online and by phone when trying to reach Covered California call centers or the live chat counselors. Just last month, the Covered California website was shut down for about a week due to software problems.
“It discourages people,” said Eric Cameron, a Farmers Insurance Group agent on Howe Avenue in Sacramento. “But until they hire more people to take calls and answer people’s questions, there’s no way around it.”
Cameron said he’s done about 30 or 40 policies since January, but it hasn’t always gone smoothly. At times, he’s been put on hold for more than two hours with 150 agents ahead of him in the Covered California phone queue.
“I’ll sit and do other work or take other calls. It’s very frustrating,” said Cameron, an auto, home and life insurance agent.
There’s also been confusion as various pieces of the Affordable Care Act have been postponed or delayed, including last week when the Obama administration announced that some individuals could keep their existing polices an additional two years. (That provision did not affect Californians.)
“There’s a lot of confusion,” said Carrie McLean, customer care director for eHealthInsurance.com, an online comparison site based in Mountain View, who said some people mistakenly assume they’ve already missed the deadline to enroll. Others, she noted, gave up applying online when hit by technical glitches.
Covered California spokesman Kennedy said the site has hired additional staffers for its call centers and online live chat feature and expects to be fully functional during the next three weeks.
“We think the additional staff and people we have in place now will handle the volume,” said Kennedy, who says an “I’m In” marketing push on TV and radio is encouraging uninsured Californians, especially Latinos who have been underrepresented in enrollments, to sign up before March 31. “We know there are thousands of Californians out there who can enroll and be eligible for the premium assistance … It’s just like taxes. People wait until the last minute to file,” he said.
Kennedy encouraged uninsured consumers to seek out an insurance agent or go online to the Covered California website for help in signing up.
What it’s costing
The new policies must all provide 10 essential benefits, including prescriptions, maternity/newborn care and free preventive screenings for cholesterol, diabetes and high blood pressure. No one can be denied based on a pre-existing medical condition. Premiums vary based on family size and the complexity of medical coverage you select.
Covered California hasn’t compiled stats yet on what average premiums are for individuals or families buying the new policies.
But eHealthInsurance.com, one of the country’s biggest health insurance websites, recently created an online data chart that calculates average premiums in all 50 states, based on thousands of its users who’ve bought the new policies. In California, the average monthly premium for non-subsidized policies is $331 for an individual and $835 for a family. That’s slightly above the national average of $309 and $732 respectively, according to eHealthInsurance.
What you’ll need
If you’re applying for a new policy, you don’t need your medical records, since pre-existing conditions aren’t considered. McLean recommends that you have a list of your prescriptions and your doctors, so that you can choose a plan that best covers your drug costs and lets you keep your existing physicians. To apply for subsidies, individuals also need to have their family members’ Social Security or taxpayer ID numbers.
How to find help
For those who don’t get health insurance at work, there are multiple ways to buy a new policy: from a licensed insurance agent; through the Covered California website; from enrollment counselors at community-based groups, like Planned Parenthood or the NAACP; and from online comparison sites like eHealthInsurance.com.
On Covered California’s site, you can type in your ZIP code to find a list of local organizations and local insurance agents who sell plans, as well as the languages in which they’re fluent, including Hindi, Mandarin, Spanish and Vietnamese.
Frank Kwong, a 25-year insurance agent in south Sacramento, said he’s written about 30 to 40 policies since the Oct. 1 open-enrollment season started, everyone from “people who’ve had no insurance ever to people who had it before but could no longer afford it.”
Kwong, who speaks Cantonese, said he’s also helped individuals who aren’t fluent in English get help with navigating the Covered California sign-up process.
Agents like Kwong and Cameron went through Covered California training and paid a small fee to be certified to sell the new policies. When they sign up clients with a health care company, they either receive a small percentage of the monthly premium or get paid a set fee, maybe $50 to $100.
Although it’s about half of what typical policies earn for insurance agents, Kwong says it’s not about the money. “When people come in, it’s a positive thing to do,” especially for those who’ve lived without health coverage, he said. “Why expose yourself to no insurance coverage? If anything happens, it could put you into a troubled state financially.”
Avoid the penalty
Some uninsured Americans may not realize that if they don’t sign up for health care by the March 31 deadline, they will likely face penalties when filing their 2014 tax return next year.
Currently, the penalty is $95 per person or 1 percent of annual household income, whichever is greater. (If income is below $10,150, no penalty is owed.) For a family, the penalty is assessed per adult, with children under age 18 paying $47.50 each. The maximum penalty per family for 2014 is $285.
Starting in 2015, the penalties go up, to 2 percent of income or $325 per person; in 2016, it’s 2.5 percent of income or $695 per person.
Those who miss the deadline can still buy health insurance in the private marketplace, but will not be eligible for subsidies. And they’ll likely get stuck with a penalty on next year’s taxes.
Will the prospect of hundred-dollar-and-up penalties goad people into signing up by the March 31 deadline?
“I’m hoping there’ll be a last-minute rush,” said eHealthInsurance’s McLean, “because there’ll be a sad wake-up call when they try to apply (for health insurance) after that date. … To wait until next January to get coverage is a long time.”