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Health Care

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Americans have until Dec. 23 to buy health plans that take effect Jan. 1 through healthcare.gov. The Obama administration's latest numbers (PDF) show that, through the end of November, 2.3 million people applied and were judged eligible to purchase coverage through the site or other state-based marketplaces, but only 365,000 of them had actually selected a health plan.

The next big risk ahead for the Affordable Care Act: if people who believe they've enrolled in insurance can't get care when they start showing up to clinics and hospitals in January.

That's what happened to Medicare patients in 2006, when a new drug benefit took effect. As the New York Times reported at the time:

People who had signed up for coverage found that they were not on the government's list of subscribers. Insurers said they had no way to identify poor people entitled to extra help with their drug costs. Pharmacists spent hours on the telephone trying to reach insurance companies that administer the drug benefit under contract to Medicare.

Given the depth of the technical failures that plagued healthcare.gov and some state marketplaces, the risk of the same thing happening to Obamacare enrollees next month is real. In cases where the government website sent bad or incomplete information about applicants to insurers, government workers are correcting the records by hand, Health and Human Services Secretary Kathleen Sebelius testified Wednesday.

If you're seeking coverage starting Jan. 1, 2014, here's what you can do to minimize the risk of problems.

1) Apply for insurance early. While the White House extended the deadline to apply for Jan. 1 coverage to Dec. 23, that gives insurance companies just a week to process applications, bill enrollees, and send new members their insurance cards. "The earlier you do it ... gives you the best chance to actually have your card in hand by Jan. 1," says Brian Lobley, vice president of marketing at Independence Blue Cross in Philadelphia.

States running their own exchanges may have earlier deadlines. (In Oregon, where the website has not been able to enroll a single person, the state set a Dec. 4 deadline to apply by mail-but thousands of people who met that deadline won't have their applications processed in time for coverage to start next month, the AP reported.) If you aren't eligible for subsidies-you can check with the Kaiser Family Foundation's subsidy calculator -it may be easier to compare plans on healthcare.gov but apply directly through an insurer's website.

2) Choose a health plan. If you've started the application process, make sure you complete it by choosing a health plan. This may sound like a no-brainer, but only one in six people who applied through the exchanges and were judged eligible to enroll had selected a plan by the end of November, according figures the Obama administration released this week. After the White House announced improvements to healthcare.gov on Dec. 1, officials started emailing and calling people who were thwarted when they first attempted to get coverage, encouraging them to try again.

3) Pay your premium. "Until someone has paid their first-month premium, their coverage is not going to be in effect," says Robert Zirkelbach, spokesman for America's Health Insurance Plans, the health insurance lobby. Some plans may offer an option to pay online immediately when you enroll. Others may bill enrollees by mail. If you haven't made a payment by New Year's Eve, though, don't count on coverage to be in effect for the next month. Call your insurer if it's not clear how to make a payment.

4) Confirm your coverage. "There are some cases in which the health plan has not received the enrollment file at all," Zirkelbach says. Most health plans will send new enrollees a "welcome package" that includes information about the plan benefits, an insurance card, and a policy number. That won't happen if an insurance company never got the application from healthcare.gov. If you but haven't heard from your insurer, call the company. Healthcare.gov also has a customer service line (1-800-318-2596) that you can try if your insurer can't confirm your enrollment.

5) Make sure your doctor takes your new plan. Many of the plans offered on the exchanges have more limited networks of doctors and hospitals than the health insurance offered by large employers. If you didn't check whether your doctor accepts the plan you bought before you enrolled, ask when you make an appointment.

If people signing up in the marketplaces can visit their doctors next year without a headache, it will be a significant success for Obama's signature law. But if many who tried to get coverage face the kind of obstacles that greeted Medicare patients in 2006, it could make the crisis this fall over a broken website look like a prelude to a much bigger problem.