This week the Center for Medicare and Medicaid Services (CMS) released new guidelines for a mid-year enrollment for health insurance. Enrollments can be completed completed through Healthcare.gov outside of the annual Open Enrollment (November 1st 2015 through January 31st 2016). However, they need to be accompanied by a Qualified Life Event. These Qualified Life Events create a window of 90 days to enroll in another health plan. This 90 day period is called a Special Enrollment Period. This 90 day window is accepted by private insurance companies. It allows individuals to enroll in a private plan or to go through Healthcare.gov and enroll with a subsidy.
In the past…
Only private insurance plans (not through Healthcare.gov) were double checked to verify a legitimate Qualified Life Event, meaning if someone wanted to complete a mid-year enrollment they could simply “Attest” (check a box on Healthcare.gov). This would be accepted by the health plan mid-year with no waiting period for services. As a result people would wait until they were sick to sign up. Many insurance companies experienced significantly detrimental bills from individuals who enrolled just for a short period of time (for example to have one major medical condition taken care of) then dropped the plan. This results in increased rates for everyone who kept the plan for multiple years.
Healthcare.gov is requiring documentation to be submitted for all mid-year enrollments. This is an expected change, and it brings Healthcare.gov up with the current requirement we’re seeing from every private insurance company. This seems to be part of the bigger issue of preventing fraud, which the Associated Press reported on earlier this week. Hopefully this will also reduce the amount of unqualified mid-year enrollments and lower the premiums!