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Affordable Care Act Enrollment Numbers Include People Who Never Paid

a pharmacist
NC Department of Health and Human Services

This week, Blue Cross Blue Shield of North Carolina announced that 6,400 people went all the way through the process of enrolling for a plan on the federal exchange, but never paid their first month's premium. Thus, they were never eligible to receive benefits. The federal government, however, has been including those people in its tally of newly enrolled individuals.

The Affordable Care Act requires that individuals pay their first month's premium before they can receive benefits.

A spokesperson for the U.S. Centers for Medicare and Medicaid Services says that the program has not been set up to count individuals based on whether or not they made their first payment - only if they completed the initial phase of the enrollment process.

BCBSNC says these people are only considered "partially enrolled." All in all, about 108,000 North Carolinians had enrolled in the federal exchange through January.

The final deadline for BCBSNC enrollees to pay for coverage beginning January 1st was January 24th. Lou Borman, a spokesman for the company, says, to his knowledge, none of those 6,400 individuals received benefits that weren't paid for.

It's unclear exactly how many people fall into this category nationwide (DHHS doesn't have that number). Aetna, the parent company of Coventry, (the second company facilitating the federal exchange in North Carolina) says it has enrolled 135,000 people nationwide and 70% have made their first payment. That would mean about 40,500 have not paid.*

These numbers are kept and the deadlines determined on an insurer-by-insurer basis -- that's why CMS says it doesn't know how many people have enrolled but not paid.

People still have the opportunity to enroll through March 31st using Blue Cross Blue Shield, for coverage that would go into effect later this spring. While they won't have to go through the entire process again, they will have to select a plan again and, eventually, make a payment.

*Correction: An earlier version of this article stated that 9,500 people had not paid Aetna. The percentage was correct, but the number was not.

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