Will a shorter sign-up period bring healthier people into the risk pool?
In the midst of ongoing uncertainty over the fate of the Affordable Care Act (ACA), the Trump administration, through the Centers for Medicare & Medicaid Services (CMS), recently put forth a new set of regulations for the 2018 exchange marketplace. Major changes from previous years include shortening the open enrollment period, putting tighter restrictions on signing up outside of that period, and transferring more oversight of the exchange plans to the states.
These regulations, the CMS contends, will bring stability to a health insurance marketplace currently plagued with high-profile exits of large insurers from state exchanges and congressional fighting over the future of the ACA. CMS Administrator Seema Verma said in a statement that the changes “will help stabilize the individual and small-group markets,” adding “they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”
45 Days to Sign Up
The new regulations shrink the open enrollment period from the previously set three months (Nov. 1 to Jan. 31, 2018) to 45 days (Nov. 1 to Dec. 15). In addition, individuals applying for health coverage during a special enrollment period (SEP) following a job loss, birth of a baby, marriage, divorce, or other life-changing circumstances must provide documentation of those qualifying events before being granted a policy. The CMS, however, said it will be flexible in imposing the verification rules and take into account an individual’s inability to send the required documents.
CMS officials assert that curtailing the enrollment time slots, particularly for SEPs, discourages people from signing up only when they face a health crisis and then dropping coverage soon after they recover. With an extended open enrollment period, people may delay obtaining coverage until a medical need arises. CMS hopes to push healthier people into the risk pool by shrinking this period.
However, a 2014 report from Express Scripts revealed enrollees who waited until the end of the enrollment period to buy coverage were generally younger and had fewer chronic health problems. These results, HealthAffairs.org concluded, “[contradict] the idea that those enrolling later are necessarily a worse risk for insurers.”
Though this may appear to be a major shift, the Trump administration only moved these changes up a year. Open enrollment periods were set to become abbreviated starting in 2019, according to Cornell University Law School.
A reset of the open enrollment period isn’t the only revision the CMS has proposed. Under the new regulations, states have been granted greater latitude to certify exchanged-based health plans within their borders, ensure issuers are licensed and in good standing, review covered drug lists and cost-sharing rules, and determine if exchange policies offer adequate provider networks.
The Center for Consumer Information and Insurance Oversight — a unit of CMS that oversees ACA — stated the intent of these regulations is to shift health insurance authority back to the states. “We seek to ensure that policies empower states to make decisions that work best for their markets, understanding there are differences from state to state,” the CIIO stated. This policy keeps with a major tenet of the GOP’s failed health care proposals that sought to give more regulatory supervision of health care to the states.
Know the Deadlines
If any of your clients are enrolled or will need to enroll in an ACA state exchange plan, inform them of the new deadline and the revised SEP requirements. If they miss the enrollment date, they could be left without health coverage. Last year, a wave of enrollees forced the CMS to extend the sign-up period. That might not happen again for 2018.
Stay up-to-date on frequent CMS changes to the ACA exchange plans. In 2016, the CMS announced a slew of modifications to 2017 plans, including limiting “surprise bills” and permitting people undergoing care to retain coverage for 90 days if their policy was terminated without cause.
The healthcare debate is far from over, so now might be a good time to reinvigorate your lead generation efforts ahead of the 2018 open enrollment period. Position yourself through internet marketing as the go-to source for health insurance guidance. Invest in internet leads from a reputable lead generation source. And always explain to your clients and prospects the value of health coverage.