Reform Update: More deadlines extended as exchanges witness surge in enrollments

The deadline for purchasing insurance coverage that starts Jan. 1 through the federal online marketplace passed as Christmas Day began. But federal officials signaled some wiggle room for consumers who tried to meet the deadline but were stymied by problems with the website.

Those individuals were instructed to contact the federal call center for further assistance. “We have developed a robust casework process to address individual inquiries, respond to specific situations and help consumers transition to new coverage,” CMS spokeswoman Julie Bataille wrote in a blog post Tuesday. “Consumers will hear directly from their health plan about the date their coverage is effective.”

The announcement was just the latest delay as federal officials seek to get as many people signed up for Jan. 1 coverage as possible given the technical problems that plagued HealthCare.gov in October and November. Originally, the deadline was Dec. 15 for coverage that takes effect at the start of 2014.

Some states that are running their own exchanges have opted for further delays. California announced Tuesday that individuals who had started applications by Dec. 23 would have four additional days to sign up for coverage, although they would need to contact the state's call center to complete their enrollments. In Minnesota, Rhode Island and Massachusetts, individuals will have until the final day of 2013 to select coverage that begins Jan. 1.

Federal officials indicated that they continued to see a surge in enrollments as the deadline for 2014 coverage approached. On Monday, more than 2 million individuals visited HealthCare.gov, according to the CMS. Of those, 129,000 were directed to the website's “queuing system” because of traffic congestion. They were then sent e-mails encouraging them to return to the online marketplace when traffic had ebbed. President Barack Obama said last week that more than 500,000 individuals had enrolled in private health plans through the federal marketplace during December—roughly four times the level of enrollments in October and November combined.

State exchanges also witnessed a late surge in enrollments. The Washington Health Benefit Exchange reported that 10,000 individuals signed up for private health plans on Dec. 23 alone. That's 15% of total enrollments since the exchange opened for business Oct. 1. California announced Monday that it had topped 400,000 enrollees in private plans.

Including enrollment in plans through state marketplaces, Obama said, 1 million Americans had enrolled in exchange plans since open enrollment started Oct. 1. However, the number remains well behind pace to meet the 7 million enrollments projected by the Congressional Budget Office by the close of the March 31 sign-up period.

There is broad confusion among consumers about the terms that health insurers use to explain pricing—especially among those who don't have insurance. That's the finding of a recent study led by the Urban Institute's Sharon Long and published in Health Affairs.

Of nine variables (e.g. deductibles and premiums), the study found that fewer than half of uninsured respondents were “very or somewhat confident” that they understood all but one such cost factor. Fewer than a third of uninsured respondents expressed confidence that they understood how it works. That lack of knowledge about how insurance prices are calculated could make it difficult for consumers to make smart choices when selecting plans through the state and federal exchanges. The nationwide survey queried more than 7,000 non-elderly adults.

Follow Paul Demko on Twitter: @MHpdemko