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Health

Feds tighten when people can enroll in Obamacare plans

Jayne O'Donnell
USA TODAY

Bowing to pressure from insurers, federal officials on Tuesday tightened the conditions under which people can sign up for plans on the HealthCare.gov exchange outside open enrollment.

Alina Nurieva, right, sits with Gabriela Cisneros, an insurance agent from Sunshine Life and Health Advisors, as she picks an insurance plan available in the third year of the Affordable Care Act at a store setup in the Mall of the Americas on Nov. 2, 2015, which was the second day of enrollment. Others often start far later and even past the deadline.

The move by the Centers for Medicare and Medicaid Services comes after complaints by health insurers that it was too easy for people to wait until they were sick to sign up and to drop coverage after they got treatment. Earlier Tuesday, UnitedHealth announced a 19% drop in profit and downgraded its earnings forecast citing concerns about its Obamacare enrollment and the flexibility people had to change insurance plans.

CMS announced it would eliminate six more "special enrollment period" categories, a month after dropping the one that allowed people to enroll late if they became surprised by the penalty they face for not having insurance at tax time. This year, special periods will not be allowed for people, including non-citizens who had errors in their premium tax credits and others who weren't aware of mistakes or eligibility. .

The state and federal exchanges have to work well for consumers, but they also "must be attractive for insurance companies that offer plans on it," said HealthCare.gov CEO Kevin Counihan in a blog post late Tuesday.

CMS also issued guidance to clarify just who is eligible to sign up during special enrollment periods, which Counihan said is designed to prevent abuse.

Katherine Hempstead, director of the insurance coverage team at Robert Wood Johnson Foundation, called the move “a tangible and timely response.”

“It remains to be seen what the impact will be, but this suggests awareness that for the market to succeed in the long run, CMS needs to focus on more than the consumer experience and getting ‘butts in the seats,’” said Hempstead. “It also needs to ensure that there are market conditions that are conducive to sellers as well as buyers.”

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