The Centers for Medicare and Medicaid Services is now requiring consumers who sign up for health insurance coverage during special enrollment periods to submit proof of eligibility, a move that the health insurance industry is applauding.
The Centers for Medicare and Medicaid Services is now requiring consumers who sign up for health insurance coverage during special enrollment periods to submit proof of eligibility, a move thatthe health insurance industry is applauding.
The purpose of special enrollment is to allow individuals who are facing life transitions such as job changes, relocations, marriages and births, to gain health insurance.
CMS is now requiring proof of eligibility for special enrollment, establishing a validation process.
Last month CMS said it would cut down on the number of special enrollment periods.
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On Wednesday, CMS announced that consumers applying through the most common special enrollment periods in the 38 states that use the Healthcare.gov platform, will need to submit documentation to verify their eligibility.
"This represents a major overhaul of the SEP process," said Health Insurance Marketplace CEO Kevin Counihan and CMS Deputy Administrator and Director of the Center for Program Integrity Dr. Shantanu Agrawal.
America's Health Insurance Plans said CMS's new documentation process is a much-needed step in the right direction to correct the instability created by special enrollment consumers who sign up only when they need coverage.
"While we are still reviewing the operational details, including the timing associated with verification, this latest effort will ensure qualified enrollees have access to coverage during important life transitions while also cutting down on the abuse and misuse of special enrollment periods which lead to higher costs for consumers," AHIP spokeswoman Clare Krusing said Wednesday.
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The number of consumers enrolling through a special enrollment period is growing, and these individuals incur significantly higher medical claims than those who enroll during open enrollment, according to analysis released this month by AHIP and Blue Cross Blue Shield Association.
During the first two years of the exchange, up to one-third of enrollees gained coverage through special enrollment, the organizations said. The actuarial firm Oliver Wyman reported these individuals amassed 24 percent more in healthcare costs over their first three months of coverage in 2014 than those signing up during the open enrollment period.
Also, individuals who enroll during special enrollment are more likely to drop coverage by not paying their premiums before the end of the coverage year, AHIP and BCBSA said.
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Consumers who wait until they need medical care to purchase coverage and stop premiums payments before the end of the coverage year destabilize the marketplace, decrease affordability, discourage enrollment, and drive up costs for everyone, the organizations said.
In the third year of the exchanges, 12.7 million people signed up for health insurance coverage during the open enrollment period, which ended January 31, according to CMS.