The Obama administration, responding to complaints from insurance companies, announced several steps on Tuesday that will make it harder for consumers to obtain health insurance after the annual open enrollment period.
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Insurers say many consumers have belatedly signed up for coverage under the Affordable Care Act when they become sick and need care. Those latecomers drive up costs for people who sign up during the regular open enrollment period, insurers say. Open enrollment ends this year on Jan. 31.
The administration, which had created more than 30 “special enrollment” periods, sent emails to millions of Americans last year urging them to see if they might be eligible to sign up after the annual open enrollment deadline. But, insurers and state officials said, the federal government did little to verify whether late arrivals were eligible.
Kevin J. Counihan, the chief executive of the federal insurance marketplace, said Tuesday that special enrollment periods “are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.”
Mr. Counihan said the administration would eliminate six of the special enrollment periods, including two for certain lawfully present noncitizens who experienced “system errors” and “processing delays” when they used HealthCare.gov. In addition, he said the government would clarify eligibility standards and step up enforcement to prevent abuse of special enrollment periods.
The actions appeared to have several purposes: to motivate consumers to sign up by the Jan. 31 deadline; to prevent an influx of large numbers of sick people into the market in the middle of the year; to persuade insurers to enter or stay in the public insurance marketplace; and to minimize rate increases in 2017 and later years.
Federal officials said nearly 950,000 people used special enrollment periods to get coverage through HealthCare.gov from late February to the end of June 2015. In some cases, insurers said, consumers dropped coverage soon after receiving costly medical services.
The marketplace must be attractive not only to consumers, but also to insurers, Mr. Counihan said. “Building an attractive marketplace starts with establishing a predictable, stable set of rules that help to keep the risk pool balanced,” he said, referring to the mix of healthy and unhealthy customers.
Most of the special enrollment periods will still be available, for example, when people marry, have a baby, lose job-based coverage or become ineligible for coverage under a parent’s health plan at the age of 26.
People will still be eligible for late enrollment when they permanently move to a new address outside the coverage area of their health plan. But the administration said Tuesday that “this special enrollment period cannot be used for a short-term or temporary move where the consumer doesn’t plan to stay in their new location.” And consumers would not qualify just because they were admitted to a hospital in another state.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, welcomed the administration’s steps but said they did not go far enough. “While this is an important first step,” she said, “more needs to be done to validate special enrollment requests.”
Insurers had, for example, urged the administration to narrow the “exceptional circumstances” in which the federal government could grant a special enrollment period.
In a blog post on Tuesday, Mr. Counihan said, “Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods.”
In addition, he said, officials will emphasize to consumers that “they may be subject to penalties under federal law if they intentionally provide false or untrue information.”
http://www.nytimes.com/2016/01/20/u...column-region®ion=top-news&WT.nav=top-news
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Insurers say many consumers have belatedly signed up for coverage under the Affordable Care Act when they become sick and need care. Those latecomers drive up costs for people who sign up during the regular open enrollment period, insurers say. Open enrollment ends this year on Jan. 31.
The administration, which had created more than 30 “special enrollment” periods, sent emails to millions of Americans last year urging them to see if they might be eligible to sign up after the annual open enrollment deadline. But, insurers and state officials said, the federal government did little to verify whether late arrivals were eligible.
Kevin J. Counihan, the chief executive of the federal insurance marketplace, said Tuesday that special enrollment periods “are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.”
Mr. Counihan said the administration would eliminate six of the special enrollment periods, including two for certain lawfully present noncitizens who experienced “system errors” and “processing delays” when they used HealthCare.gov. In addition, he said the government would clarify eligibility standards and step up enforcement to prevent abuse of special enrollment periods.
The actions appeared to have several purposes: to motivate consumers to sign up by the Jan. 31 deadline; to prevent an influx of large numbers of sick people into the market in the middle of the year; to persuade insurers to enter or stay in the public insurance marketplace; and to minimize rate increases in 2017 and later years.
Federal officials said nearly 950,000 people used special enrollment periods to get coverage through HealthCare.gov from late February to the end of June 2015. In some cases, insurers said, consumers dropped coverage soon after receiving costly medical services.
The marketplace must be attractive not only to consumers, but also to insurers, Mr. Counihan said. “Building an attractive marketplace starts with establishing a predictable, stable set of rules that help to keep the risk pool balanced,” he said, referring to the mix of healthy and unhealthy customers.
Most of the special enrollment periods will still be available, for example, when people marry, have a baby, lose job-based coverage or become ineligible for coverage under a parent’s health plan at the age of 26.
People will still be eligible for late enrollment when they permanently move to a new address outside the coverage area of their health plan. But the administration said Tuesday that “this special enrollment period cannot be used for a short-term or temporary move where the consumer doesn’t plan to stay in their new location.” And consumers would not qualify just because they were admitted to a hospital in another state.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, welcomed the administration’s steps but said they did not go far enough. “While this is an important first step,” she said, “more needs to be done to validate special enrollment requests.”
Insurers had, for example, urged the administration to narrow the “exceptional circumstances” in which the federal government could grant a special enrollment period.
In a blog post on Tuesday, Mr. Counihan said, “Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods.”
In addition, he said, officials will emphasize to consumers that “they may be subject to penalties under federal law if they intentionally provide false or untrue information.”
http://www.nytimes.com/2016/01/20/u...column-region®ion=top-news&WT.nav=top-news
