Feds will soon require proof for special Obamacare enrollment periods
Consumers who try to sign up for insurance after the Obamacare open enrollment period will soon need to submit proof that they are eligible for most special enrollment periods, federal health officials announced Wednesday.
This new confirmation process, which is expected to start in the next few months, will only affect those living in the 38 states that use the federal Healthcare.gov site.
It addresses complaints from insurance companies that the Centers for Medicare and Medicaid Services was allowing too many people to buy insurance after the open enrollment deadline passed. This, insurers said, left them with many consumers who waited until they were sick to sign up and then dropped coverage after they received treatment. And the companies claim that created a sicker-than-expected pool of customers that was contributing to the losses on Affordable Care Act exchange plans.
CMS has already reduced the number of personal situations that can trigger a special enrollment period (SEP). In this next step, anyone who tries to enroll or change plans using an SEP for five different situations will have to provide documentation. These are a permanent move, birth, adoption or placement for adoption or in foster care, marriage, divorce or anything else — such as job loss — that causes a person to lose the "minimum essential" insurance coverage now required by the ACA.
As of now, all consumers have to do is check a box saying they attest that they meet the conditions for special enrollment. Under the new process, people will need to upload or mail copies of documents such as their birth or marriage certificates to prove they qualify.
CMS is seeking comments from consumer advocates, insurance companies and others on the new process, such as communication with consumers, acceptable documentation, and the verification process that the agency will consider as it implements the new process.
Families USA, a nonprofit group supporting more access to health care, said Wednesday that CMS needs to be careful about excluding people with serious needs.
“Most consumers are still learning about how the new health insurance marketplaces work, how to navigate a complex enrollment process, and when to apply," said Rachel Klein, the group's director of organizational strategy. "In fact, data show that fewer than 15 percent of those eligible for SEPs have used them. The administration should focus on raising consumer awareness about these opportunities instead of putting bureaucratic roadblocks in the path of people trying to protect their health and that of their families."
