You Are Paying For Misuse Of Obamacare Enrollment Periods

As you can see below, federal officials will try and fix this abuse soon. Soon?  This is 2016, six years after the Law was enacted and concern over this kind of gaming the system or adverse  selection was a topic of concern even before the law was passed.  Please understand, this is a problem not for insurance companies, but for their policyholders paying premiums and taxpayers paying to subsidize those premiums. 

Insurers Say Costs Are Climbing as More Enroll Past Health Act Deadline
The New York Times (01/10/16) P. A16 Pear, Robert

Health insurers say the more than 30 “special enrollment” categories created by the Obama administration allowed large numbers of people to enroll in coverage after the open enrollment deadlines in the last two years, destabilizing insurance markets and boosting premiums.

Insurers and state officials contend that the federal government failed to verify that these individuals actually were eligible, enabling people to wait until they become ill or need medical services to enroll. “State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period,” said the National Association of Insurance Commissioners (NAIC) in a letter to the U.S. Department of Health and Human Services. “We know of many cases where individuals with serious medical conditions purchased coverage midyear by simply checking the right box or using the right language, and their eligibility was not questioned.”

Federal officials stress that people must be able to sign up late when they have legitimate reasons, but they will outline their plans soon to prevent misuse or abuse of special enrollment periods.

Here are a few of the special exceptions from last year:

  • There was a Special Enrollment Period from March 15th, 2015 to April 30th, 2015 for those who were either confused about open enrollment or will have to pay the fee for 2014.
  • If you signed up for the Marketplace but didn’t complete the enrollment process, you had until February 22nd to complete enrollment due to a short Special Enrollment Period. Some states have unique extensions. See state extensions.
  • If you had trouble signing up or had a plan from last year, you’ll need to attest that your trouble signing-up was due to a website or call center problem. You may be granted a short special enrollment period.

There are several situations that are legitimate reason for mid-year enrollment such as marriage, birth of a child, loss of a job, etc. However, as time goes by there should be less need for special enrollment periods without penalty such as those above. The system is working and people can easily learn how to enroll. Americans by now are supposed to have coverage and there should be little need to accommodate late enrollment at everyone else’s expense. 


1 reply »

  1. Let’s all cry together. Fact is that most people who need individual insurance and would select against the system are already covered – Medicaid or public exchange. So, chances are that those who enter late have average claims experience that is not substantially worse than the average claims experience of those enrolled as of 1/1 each year. Would love to see the data.


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