To ensure that the Marketplace is strong, and able to provide affordable health insurance coverage to Americans in all states, the Marketplace must cultivate a healthy risk pool. In other words, the Marketplace needs to enroll a mix of those who are actively treating and those who simply need preventative care. With this goal in mind, HHS made three announcements in June about their efforts to strengthen the risk pool.
These efforts include:
- Curbing abuses of short-term plans that exploit gaps in current rules to use medical underwriting to keep some of the healthiest consumers out of the Affordable Care Act’s single risk pool.
- Improving the risk adjustment program to more accurately reflect the cost of partial-year enrollees and to incorporate prescription drug utilization data that provide a more complete picture of enrollees’ health status. These improvements will ensure that the program continues to work as intended to compensate issuers with higher-risk enrollees and thereby help issuers sustainably serve all types of consumers.
- Helping consumers who turn 65 make the transition to Medicare, so that older consumers are served by the program designed for them and their health needs.
- Beginning full implementation of the Special Enrollment Confirmation Process, which ensures that eligible individuals continue to have access to coverage through Special Enrollment Periods (SEPs), but prevents people from misusing the system to enroll in coverage only if they get sick.
- Continuing efforts to reduce data-matching issues (DMIs). CMS outreach, education, and operational improvements have contributed to a sharp reduction in total data matching issues generated and an almost 40 percent year-over-year increase in documents submitted to help resolve income and citizenship and immigration data matching issues. Improving the resolution of DMIs benefits the risk pool because it keeps eligible consumers, often younger and healthier consumers less motivated to overcome obstacles such as extra paperwork, from losing coverage mid-year.
Here at WAP, we are particularly interested in transition of consumers to Medicare at age 65. Below is some additional information from HHS on that front:
The Marketplace serves as an essential backstop for consumers as they transition between different types of coverage over their lifetime. For example, many early retirees access Marketplace coverage until they become eligible for Medicare when they turn 65. But once individuals turn 65, most people should end their Marketplace coverage and switch to Medicare. In fact, if consumers do not enroll in Medicare Part B when they turn 65, they could face financial consequences for years into the future, because they could owe higher Medicare premiums. Meanwhile, the Marketplace is intended to serve consumers who are not Medicare eligible, and continued enrollment by individuals who are eligible for Medicare can raise costs for other consumers.
To make sure consumers understand the steps they need to take to move to Medicare, this summer the Marketplace will start contacting enrollees as they near their 65th birthday. This outreach will provide consumers with the information they need to enroll in Medicare if they are eligible and end their Marketplace coverage if they choose to. This builds off the changes we made to the HealthCare.gov application this year which included new pop ups with reminders for consumers who are about to turn 65 that they may be eligible for Medicare.
If you have clients who are turning 65, remind them to move to Medicare! As always, we are your best resource for Medicare supplement insurance and Medicare Advantage insurance products. Please let us know how we can help you be successful.
