Health insurers are bombarding Obamacare administrators with complaints that people are waiting to get sick before buying health insurance and then dropping it once they are cured. They want the rules and verification system for special enrollment period (SEP) sign-ups to be clarified and tightened.
“Many individuals have no incentive to enroll in coverage during open enrollment, but can wait until they are sick or need services before enrolling and drop coverage immediately after receiving services, making the annual open enrollment period meaningless,” wrote Steven B. Kelmar, executive vice president of Aetna, to Health and Human Services (HHS) Secretary Sylvia Burwell.
“State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period,” wrote the National Association of Insurance Commissioners in a letter to the HHS. “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.”
The acting administrator for the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt, told an audience Monday that his agency needs to review SEP rules because there is evidence of abuse. “There may be bad actors and others out there who are abusing those [rules],” he said.
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