Four days.


If you don’t already have a health insurance plan for next year, and if you don’t think you can afford to live without one for even one month, these next four days will be crucial.


That’s how long you have until the Dec. 23 deadline to pick a health insurance plan on HealthCare.gov and get coverage starting Jan. 1.


The deadline to pay the first premium, originally set at Dec. 31, was extended Wednesday to Jan. 10 by America’s Health Insurance Plans, the insurance industry’s biggest trade group.


For people who believe they can do without coverage, March 31 is the important deadline. That’s when the enrollment period ends and they face a federal fine if they remain uninsured.


Timothy McBride, health economist at Washington University in St. Louis, said he believed young adults would wait until March to sign up.


“The people who are healthier tend to procrastinate more,” he said.


They may not be sick enough to believe they need insurance, he said, but they could also want to avoid the penalty — $95 per uninsured person or 1 percent of household income, whichever amount is greater.


Still, waiting is a risk because accidents and illnesses happen. And people with chronic conditions may not be able to afford any lapse in coverage.


For those who need the coverage in January, the deadline is almost here.


But it may not be as simple as selecting a plan and paying the premium. Many people who have used the online health exchanges have reported not receiving confirmation of their payments for days or even weeks.


And while the HealthCare.gov marketplace appears to be running more smoothly, delays and minor glitches could make a last-minute signup nerve-wracking and unreliable.


Navigators and certified application counselors — people designated to help with insurance marketplace applications — are relying on HealthCare.gov to withstand the last-minute rush of shoppers.


“We’re cautiously optimistic that the fixes that have been made will be able to handle the volume of users,” said Mike Claffey, a spokesman for the Illinois enrollment campaign called Get Covered Illinois.


And so, enrollment campaigns have revved their engines to attract potential customers in time.


Cover Missouri, for example, is a campaign from the nonprofit organization Missouri Foundation for Health. The organization launched online video advertisements Dec. 6 that portray Missourians playing it “too safe” because they can’t risk an accident without health insurance.


Ryan Barker, vice president of health policy at the foundation, said the theme was inspired by multiple focus groups held with uninsured Missourians.


“One of the things we really heard is that they’re very aware of not having health insurance and it often holds them back from participating in activities because they’re afraid of going to the emergency room and having to pay that medical bill,” he said.


Radio ads, as well as the online videos, were strategically launched this month to grab consumers’ attention before the deadline, Barker said.


The Get Covered Illinois campaign released its television ads Dec. 13. Focusing on multicultural populations, the 30-second bit says “Blue collar, white collar, no collar” workers can now all be covered. Shorter segments focus on a pregnant woman and a man with a pre-existing condition.


“We’re trying to appeal to a broad cross section of the population, and I think it comes through,” Claffey said.


The campaign, which cost the state $35 million, focused on a radio and digital presence as well as educational events throughout November.


“Before, our message was to get educated, but now that it’s December, we’re urging people to pick a plan,” Claffey said.


Neither Cover Missouri nor Get Covered Illinois is neglecting social media either. Claffey said it was an important tool to reach the so-called young invincibles, or healthy young adults. Both campaigns are staying active on Facebook and Twitter with testimonials and facts about the Affordable Care Act.


But reaching individuals takes more than advertisements and a social media presence. Organizations are planning events and finding consumers on foot.


Get Covered Illinois and its 250 community partners held a statewide day of action Dec. 14 that included about 40 enrollment events.


An additional 300 events have been planned leading up to Dec. 23.


The Cover Missouri Coalition — groups and organizations partnering with Missouri Foundation for Health — also began what Barker called a “heavy push” of enrollment events at the beginning of the month.


A surge of people are expressing interest in signing up, he said, and many coalition members have reported between three and six full enrollments per counselor per day.


Some organizations are traveling to the potential enrollees instead of just setting up camp.


Planned Parenthood of the St. Louis Region and Southwest Missouri has sent certified application counselors on door-to-door missions to spread the word about the act. Counselors also approach patients in the health center lobbies and hold enrollment events as well as phone banks.


With a proactive approach since the opening of the marketplace Oct. 1, president and CEO Paula Gianino said Planned Parenthood did not need to vamp up its strategy for the December deadline.


“Consumers have done it for us,” she said, as hundreds of curious customers have been calling and visiting the health centers for help with the federal insurance marketplace.


Planned Parenthood, like other groups, also holds evening and weekend appointments to accommodate work schedules.


The St. Clair County Health Department, situated on the western border of Illinois, began holding longer hours at the beginning of December. Navigator Karen Willcutt said fliers had been placed around the community to advertise the extended hours, and as the deadline approaches, she said, the department is chalking up appointments more quickly.


“Actually, this week we are full,” she said Monday.


Still, many organizations are expecting another, perhaps larger, rush of consumers well into the new year.


Barker said Cover Missouri would ramp up marketing efforts in the first half of both January and February, with the goal of getting the uninsured to sign up for coverage by the 15th, the last day to get coverage in place by the start of the following month.


In the meantime, Get Covered Illinois and other groups are urging people to at least shop the plans online.


“But we’re also telling people, ‘If you’re not certain, you’ve got three months until the end of March,’ ” Claffey said. “It’s not the end of opportunity in the month of December.”


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