Special enrollment periods (when consumers can sign up for health insurance outside of the standard open enrollment period) are only to be used in certain qualifying circumstances. To ensure that special enrollment options are not abused, the Centers for Medicare and Medicaid Services (CMS) may be piloting a program to monitor and verify special enrollment insurance sign-ups.
There is concern that some individuals may use special enrollments to secure coverage when they become sick, adversely impacting the overall risk pool.
Over the past few months, CMS has tightened processes and added warnings to Healthcare.gov. Preliminary data suggests that these measures may have helped to reduce the total volume of special enrollments. Going forward, documentation will be required to prove an individual’s eligibility for a special enrollment.
To learn more about this issue, or to give feedback on the upcoming pilot click here. Please send your comments to CMS by September 20, 2016.
