Need to sign up for or switch health insurance plans on HealthCare.gov? The Affordable Care Act (aka Obamacare) has an annual open enrollment period for that. Outside of that window, you are stuck with the plan you have.
But life doesn’t always follow the calendar. People move, lose or leave their jobs, get married or divorced, or have a baby at all times of the year. For this group the ACA offers special enrollment periods that allow them to get insurance right away, instead of having to go uninsured until the next open enrollment period.
Plans to tighten process
Insurers have been complaining that some people are taking advantage of these special enrollment periods to get insured, have expensive medical work done, and then drop their insurance, resulting in higher costs for the insurance companies and thus higher premiums for customers. Independent experts aren’t convinced this is a significant problem but the new administration has just taken steps to tighten up the process for getting a special enrollment period anyway.
Its main tool is demanding more rigorous documentation. All along, the ACA has theoretically required people to submit proof of their “life change” in order to get cleared for special enrollment. But until now, the government hasn’t checked the documentation for everyone. Instead, it has done spot-checks and terminated people’s plans if they didn’t hand in the required paperwork.
What the proposal says
Under proposed new rules, HealthCare.gov will check the paperwork of everyone who asks for a special enrollment period. They’ll be given 30 days to mail it in or submit it electronically and will be allowed to enroll in a plan right away, but the application will be “pending” until the government clears their paperwork. At that point, coverage will be retroactive to the date they applied.
The government says it plans to start enforcing the new rule this June.
Nancy Metcalf is an award-winning independent journalist specializing in health topics. A senior writer and editor for Consumer Reports for more than 25 years, she is a nationally recognized expert on health insurance and health reform.