What you need to know about health

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

January 9, 2014 at 12:58 PM

This season the holidays just kept on giving. Seemingly each day last month, our email in boxes at HealthCare Checkup were stuffed with yet another surprise in the form of new enrollment deadlines and changed rules for getting health insurance. While other folks were slugging down eggnog and making merry, we were trying to unwrap and assemble all the shiny new changes.

Here's what you might have missed:

Folks with canceled plans

Remember all the people upset that they got letters informing them that their health-insurance plans were being discontinued? Just before Christmas, the Obama administration announced new rules that allow anyone whose plan was canceled to either buy so-called 'catastrophic' plans or go uninsured but without having to pay the penalty that kicks in at the end of March.

The change potentially affects more than 227,000 Washington residents whose individual insurance plans were scuttled this fall because they didn't comply with rules in the Affordable Care Act.

The kicker is that there is only one catastrophic plan for sale through most of the state, and there are actually cheaper, non-catastrophic plans available, so there's not a huge financial benefit to this announcement. The biggest change is the provision saying these people won't be penalized for not having insurance in 2014. But again, these are people who already had insurance, so presumably they liked being covered.

Folks who had trouble enrolling

While the state's health insurance exchange, Washington Healthplanfinder, had a better track record than most marketplaces around the nation, the site for purchasing subsidized coverage had serious challenges. Whether it was the mistakes in calculating how much of a subsidy someone qualified for, or the inability to get through to the toll free help line, many people were stymied in their efforts to get insurance through the exchange.

So last month the state bumped back some enrollment and payment deadlines. If you started - but even if you did not complete - the online enrollment process by Dec. 23, you could still have health insurance starting Jan. 1. To get that coverage, you do need to make your first insurance premium payment by Jan. 15, then the coverage is retroactive.

However, for these late applications the insurance company will likely send you information saying your coverage starts Feb. 1. The agency running the Healthplanfinder site is contacting people in this position to advise them on what steps to take, and there is more information in this sheet of frequently asked questions.

And if you didn't make the Dec. 23 deadline, not to worry! If you enroll for insurance coverage by Jan. 15, it will start Feb. 1. (See this blog post and this story for more tips on signing up.)

Small businesses

First off, small businesses with 50 or fewer employees are not required now or in the future to buy health insurance for their workers. But if you are a small employer in Washington who wants to cover your employees, you essentially have two choices in 2014: buy insurance in the small group market, or join an association or trust that offers insurance and buy it through them.

Thanks to a change announced in late December, Washington small businesses going either route could be eligible for a tax break to bring down their insurance costs.

The tax break applies to small businesses that pay at least half the cost of their workers' health insurance premiums and who employ fewer than 25 people earning on average $50,000 a year. Eligible businesses will be able to could recoup up to 50 percent of the insurance costs and nonprofits will be able to claim up to 35 percent.

Until the late-breaking change in the policy, Washington employers were going to be ineligible for the tax benefit because it's the only state in the nation that largely lacks a health insurance exchange selling plans for small businesses.

Medicaid recipients

There were two significant bits of news related to new and renewing recipients of Medicaid, which Washington officials renamed Washington Apple Health.

First, people who need to renew their Medicaid coverage will get more time to do so, the state's Health Care Authority announced at the end of December.

The renewals, called annual reviews, were originally due Dec. 31. But many clients ran into technical problems with Healthplanfinder, the new online website that is also being used to sign people up for subsidized health insurance plans. The Health Care Authority is contacting clients who missed that deadline to give them an extension. The agency is also sending letters to folks whose coverage ended in November and have not renewed their enrollment.

Second, the Health Care Authority made an emergency rule change to Medicaid policy regarding cost recovery. The former policy allowed Medicaid to take money from a client's estate after their death to pay for all of their medical costs. This rule became a problem as many more people in Washington now qualify for Medicaid for their health care.

The new rule, which took effect the first of this month, amends WAC 182-527-2742 and says Medicaid can only recover costs related to long-term care services, but not regular medical expenses or a client's managed-care costs paid by Medicaid.