June 19, 2014:
Insurers are fighting to keep teeth in the individual health coverage open enrollment rule period rules. One battle is flaring up in California.
Out west, Covered California has talked about providing 90 days of temporary coverage for consumers who are trying to prove they are eligible to apply for individual coverage outside the open enrollment period. The California Association of Health Plans (CAHP) objected.
If the proposal takes effect, “this will allow consumers that are disproportionately high-cost to enter the system at the point they need immediate care, which will skew the risk pool and make premiums less affordable and more volatile,” Athena Chapman, CAHP’s regulatory affairs director, writes in a comment letter. Covered California included the letter in a board meeting packet.
The Patient Protection and Affordable Care Act (PPACA) now requires insurers to sell individual coverage without taking personal health information into account. When insurers are pricing coverage, the only personal health status information they can use is age.
Insurers, regulators and exchange managers developed the open enrollment period system for individual major medical coverage to keep consumers from waiting until they get sick to pay for insurance. The open enrollment period for all PPACA-compliant major medical coverage started Oct. 1, 2013. The open enrollment period and enrollment period extensions sputtered out throughout the country by May 30.
Consumers who want to buy coverage today must show that they have undergone a major life event, such as the birth of a child, or that they qualify for a special enrollment period (SEP) for some other reason. Covered California has been thinking about letting consumers enroll in QHPs outside of the open enrollment period for 90 days while waiting for the exchange to verify whether they are eligible for a SEP.
Proposal supporters argue that consumers need help with keep bureaucracy and paperwork problems from interfering with access to health care. Insurers believe that letting consumers enroll in QHPs without going through eligibility determinations first will hurt the integrity of the open enrollment period, Chapman writes.
The open enrollment period “is one of the few ways that health plans have to control costs and ensure that coverage is affordable,” Chapman says.