With less than a month left to sign up for private insurance under the federal health care law, California's enrollment numbers are closing in on the magic number of 1 million as 8,000 people sign up every day.

If only everyone would pay their premiums.

Roughly 15 percent of the Californians who had enrolled by Jan. 31 still haven't sent in their first month's payment, according to four major health insurance companies participating in the Covered California exchange. So those lofty enrollment numbers could soon be dropping substantially.

"In order to receive access to health care, they need to pay their premiums," said Brad Kieffer, a spokesman for Health Net.

Health plans say they are doing everything possible to contact those enrollees who didn't pay -- through email, phone and snail mail. But it's becoming increasingly likely that tens of thousands of Californians could end up the way they started -- uninsured.

That's not to say that the insurance companies, which have an intense financial interest in making the controversial health care law work, haven't been extremely accommodating.

In late December, with huge numbers of applications piling up, all of the exchange's 11 health plans agreed to extend premium payment deadlines through various dates in January.

People who paid by the end of the grace periods saw their health insurance retroactively start the first of the year.

In other words, if someone was injured in a serious car crash on Jan. 10, he or she could pay the first month's premium after the accident and still be insured for the cost of their care.

That's usually not the way health insurance works.

Normally, individuals or businesses applying for health coverage must enclose a check for their first month's payment with their application, said Neil Crosby of the California Association of Health Underwriters, a trade group that represents 2,500 of the state's health insurance agents and brokers.

"It's like moving into an apartment -- you have to pay the first month's rent," Crosby said. "The same thing happens with health insurance policies.

"This is a brand-new phenomenon," he said of the new grace periods.

Insurance companies have always had a relatively small number of people who stop making payments over the course of a yearlong policy. But Crosby believes the insurance companies participating on the exchange were surprised by the percentage of applicants who hadn't paid up.

"They thought that when they billed for coverage, people would go ahead and pay their premiums," he said.

The numbers of nonpayers varied only slightly among the largest insurers on the exchange: Kaiser Permanente reported that 13 percent of its enrollees didn't pay. Anthem Blue Cross of California, Blue Shield and Health Net said it was closer to 15 percent.

Federal officials say they've noticed the same trend nationwide.

From Oct. 1 to Feb. 1, almost 3.3 million Americans enrolled in a health plan through 14 state-run exchanges or the federal government's once-balky-but-now-breezy health care exchange. But the Obama administration says it still doesn't know what percentage of the individuals have paid their January premiums, which represents hundreds of millions of dollars to health insurance companies.

Covered California says it hopes the percentage of non-payers will drop substantially as the March 31 open-enrollment deadline approaches. But officials there say there's little they can do about it.

"This is a partnership we are in with the health plans," said Dana Howard, a spokesman for the exchange. "The plans are best able to deal with collecting the payments. That's not what Covered California does. So we are counting on them to be able to best implement that."

There's plenty of speculation why people have signed up for health insurance and not yet paid:

  • They may have balked at the cost of the insurance and decided to pay a minimum $95 penalty instead.

  • They may have decided not to pay after discovering they had enrolled in a health plan that didn't include their doctors.

  • They may have enrolled in more than one plan by mistake.

  • Since getting the insurance through the exchange, they may have been hired by a company that provides health insurance.

    Insurance companies warn that people choosing to delay payment or remain uninsured could be placing themselves in financial jeopardy. Should they end up needing hospitalization, insurers say, the uninsured could owe tens or hundreds of thousands of dollars in medical bills.

    For some Californians, however, the biggest problem wasn't paying for a plan, it was getting confirmation that their payment had been processed.

    It took Woodside resident Jennifer Jones and her husband a nerve-racking seven weeks and two payments -- the first paid by check, the second online -- before their insurance company finally acknowledged that they were insured.

    "It was extremely chaotic, just a nightmare," said Jones, a marketing consultant, who stopped payment on the initial check she wrote after waiting seven weeks for the insurer to cash it.

    Contact Tracy Seipel at 408-920-5343. Follow her at Twitter.com/taseipel.

    Health insurance deadlines
    March 31 is the enrollment deadline to sign up for health insurance to avoid paying a minimum $95 penalty.
    People who want their coverage to start on April 1 must enroll by March 15. And they must pay their insurance premium by March 26.
    People who want their coverage to start on May 1 must enroll by March 31. And they must pay their premium by April 25.
    Some insurers have longer grace periods. So consumers should check with them.
    Source: Covered California