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Kathryn Johnson at her Capitola home Saturday, Sept. 21, 2013. She pays a large health care premium every month. On the eve of the Oct. 1 kickoff when Americans can start shopping for insurance under the U.S. Affordable Care Act, many Bay Area residents still aren't sure what it means to them, or how the state's healthcare exchange and subsidies work. (Patrick Tehan/Bay Area News Group)

Lynn Engelman still has no idea whether her doctors in Contra Costa County will be on her new health care plan -- and neither, she says, do her doctors.

Capitola resident Kathryn Johnson has already paid the first month's bill for her new policy through the state's new health insurance exchange, but she just received a letter telling her she hasn't signed up for a plan.

And in San Leandro, Linda Entrikin is one of 900,000 Californians suffering from whiplash after the Obama administration's surprise announcement Thursday that people whose insurance plans have been canceled can replace them with cheap, bare-bones plans after all.

For tens of thousands of Californians still without health insurance, Monday's deadline to enroll under the president's new health law feels like an exercise of hurry up and wait. And across the country, government health exchanges are bracing for an avalanche of applications from people who must sign up by end of day Monday if they want coverage to begin Jan. 1.

People in the Bay Area are scrambling to sign up too, and others are anxiously awaiting answers about the policies they already applied for.

Yet many worry they may not get what they want in time from Covered California, the state's health care exchange, or from their insurance company.

"The system is still fraught with many problems," said Johnson, 57, a self-employed psychiatric nurse practitioner.

Exchange officials acknowledge myriad issues, including incomplete applications, many of which likely won't be resolved by Monday.

In a hastily organized press call late last week, Peter Lee, executive director of Covered California, said many Californians have concerns about the status of their applications and whether they will be able to enroll on time.

By Thursday, he said 53,510 more Californians had successfully enrolled in a health plan on the exchange, for a total of at least 212,514.

Lee stressed that the quickest way consumers could still enroll in a health plan by Monday is by going online to coveredca.com, or getting in-person assistance from one of 10,000 trained county workers, 8,000 certified insurance agents and more than 2,500 certified enrollment counselors around the state.

Once their application is approved, consumers should get an invoice for the first month's premium by Jan. 1, he said, and it must be paid to the insurance company by Jan. 6.

Yet Pat Burns, owner of Burns Employee Benefits in Oakland, said confusion is rampant.

"Hopefully people understand that just because they applied they do not have coverage -- they need to get a bill, and pay the bill before coverage is effective," Burns said. "If you do not get a bill, then something is wrong."

Lee also warned that the last-minute rush to apply could overwhelm the website, though he stressed the exchange is working hard to ensure that doesn't happen.

On Wednesday, the website logged 8 million page views.

"We don't know that between now and the 23rd that the system will work flawlessly," he said. But if people miss Monday's deadline "through no fault of their own" because of technical issues on the website, he said Covered California will make sure they get signed up for a plan by Jan. 1.

Covered California's three call centers around the state -- one is in Concord -- will have extended hours, from 8 a.m. to 8 p.m. Sunday and Monday. A recently activated hotline was established to help consumers with frequently asked questions.

Amid all this, the exchange is trying to reduce a backlog of 25,000 paper applications completed in October and November that must be resubmitted through the website. And because of a computer error, the exchange recently sent incomplete eligibility notices to almost 114,000 households.

Lee said some people will miss the first deadline. But he stressed that open enrollment continues through March 31 for insurance coverage in 2014. People who don't enroll by that date will face a penalty of $95 or 1 percent of their adjusted gross income, whichever is higher.

Johnson doesn't want to wait beyond Jan. 1. The Capitola woman is a big beneficiary of the new health care law, and she has good reason to be frustrated.

Under the Affordable Care Act, insurance companies can no longer refuse or penalize those with pre-existing health problems, like her asthma and chronic back pain. Now, for the first time in years, Johnson is on the brink of celebrating an annual health insurance bill of $5,736 -- about one-sixth of her previous $31,044 annual tab.

Engelman is also nervous. She said she's been told by both Covered California and Anthem Blue Cross that if her doctors' names are not on the list of providers, "it means they have not sent in their paperwork."

"But when I asked my doctors," the Internet consultant said, "they said they had never received any paperwork."

Meanwhile, Entrikin -- a small business owner who recently bought a new Kaiser Permanente plan to replace her old one -- said she would be "happy to go through all that again and reverse course" to get her original policy reinstated.

Late Thursday, the administration relaxed the rules for millions of people whose insurance policies were cancelled because their plans did not meet the requirements of the new law. Now they can return to skimpier plans, at least temporarily.

"It has a lower deductible and less out-of-pocket costs,'' she said of her plan, which she called comprehensive, and not bare-bones. "So yeah, I will go back to my old policy."

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

LAST-MINUTE TIPS TO APPLY FOR HEALTH CARE
  • Go online at coveredca.com, or get in-person assistance from a Covered California certified enrollment counselor, insurance agent or county office. Their names should be listed on the website by ZIP code.
  • Once your application has been approved, you'll receive an invoice for the first month's premium by Jan. 1, and it must be paid to the health plan directly, not to Covered California. Most health plans accept payment by phone.
  • Payment must be received by Jan. 6 for coverage to be retroactive to Jan. 1.
  • An insurance membership ID card will be mailed to you within 10 business days after your payment has been received. An enrollment package will also be mailed with your ID card.
    Source: California Association of Health Plans

    WHAT YOU'LL NEED TO APPLY
    Consumers should have the following information ready when applying for Covered California health insurance plans:
  • The number of people being enrolled in a plan and their birth dates.
  • Social Security numbers for each family member.
  • Home ZIP code.
  • Projected income for the coverage year. This can be obtained by checking your most recent income tax filings for the adjusted gross income, any applicable dependent tax information and head-of-household status.
  • Legal immigration information, such as your immigration number.
  • Information about your status as a member of a federally recognized tribe.
  • For more information, go to coveredca.com or call 1-800-300-1506.
    Source: Covered California