Now that HealthCare.gov is working relatively well — much better than it used to be, at least — health insurers are about to ramp up a huge marketing campaign to get people to sign up for the exchanges. One national insurance network, WellPoint, told the Wall Street Journal it held off much of a massive planned campaign to enroll people in its plans until the federal marketplace (and the similarly troubled state-run exchanges) was working better. It plans to spend a casual $100 million before the end of this year on TV buys, social media, and print ads — this in an industry that spent just $216 million on TV advertising in all of 2012. In fact, according to Kantar Media, between October 1 and November 10, insurers bought up $194 million worth of local-TV time.
This campaign will last a few months: Insurers have to sign up most of their enrollees this year before March 31, the end of “open enrollment” (after which people can only buy new plans under specific circumstances).
But December 23 is a more important date for millions of Americans: those whose plans end December 31 (as most individual plans do) and want a plan from the exchanges, those who are seeing their plans canceled and don’t want to buy the new plan their insurers have offered, and the uninsured who want coverage beginning January 1. If those people don’t select a plan on the marketplace, get an invoice from their insurer, and pay their first premium by this coming Monday, they won’t have insurance on January 1, and they won’t be able to have it until February 1. Probably.
Why “probably”? The White House is pressuring insurers to give people a grace period or to begin coverage without payment. On January 1, California, for instance, will require insurers to start covering people who enrolled by December 23, whether they’ve paid or not — they’ll have until January 5 to make their payment (about a two-week extension). Aetna, a national health-insurance network, has told HHS that it will accept premium payments until January 8. There are things the federal government itself can do to ease the transition: As Yuval Levin noted last week, the narrowing window for people to purchase coverage is causing real panic in the White House, so they’ve extended the federal high-risk pools created by the Affordable Care Act a few years ago tto cover people with expensive medical problems and preexisting conditions through January. But the White House is also, apparently, having real success convincing insurers (and convincing state regulators to convince insurers) to help out too – insurers see such a rich vein of new customers this year that they’re willing to go to significant measures to make sure the new buyers end up with them, rather than a competitor.
Intense outreach could reverse one odd trend in enrollments so far: Most people using the exchanges so far are not eligible for subsidies (meaning they make, roughly speaking, more than the national median income), while the CBO predicted that the vast majority of enrollees would be. But it isn’t that surprising that savvier people with higher incomes and more flexible financial situations started looking into insurance on the early side, while it’s going to take substantial outreach by insurers (and other actors) to get to the actual uninsured, low-income population whom the law was mostly supposed to help. And the exchanges have until March 31 to enroll anyone — next week is only an important date for people who want to avoid having a gap between their existing insurance coverage and the plan they buy on the exhcnages.