A Special Enrollment Period Will Allow a Consumer to Enroll

[cadylou]

Now that will really show those who are abusing SEPs whose boss.. Yet I have never seen most of these SEPs. Hey CMS, how about you monitor your own personnel in the call centers. I sent 5 people to the marketplace, in each case, there was no QLE to get an SEP. I told each one that I could not help, but they could call the marketplace and see what happens. Each one called the marketplace and amazingly got enrolled the first of next month... I have to follow the law, hc.gov employees not so much...

This has always been the case. . .

 

[Yagents]

In a blog post on Tuesday, Mr. Counihan said, “Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods.”

http://www.nytimes.com/2016/01/20/u...trying-to-enroll-in-health-care-act.html?_r=0

 

[AllenChicago]

I don't think CMS has given Web Brokers and Insurers the new 2016 SEP rules and wording yet. Just the publically announced guidelines earlier this week.

Perhaps it doesn't matter to insurers, because the new guidelines apply to Marketplace SEP's. But for WBE's, the new guidelines must be incorporated into their SEP screener properly...if the WBE plans on offering SEP enrollments.

They'll probably be officially released on January 31st for a February 1st implementation.

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How does forcing COBRA-eligible employees to take COBRA, instead of enrolling in a Marketplace plan, deter SEP abuse? The consensus is that employees are healthier than the SEP population insurers want to avoid. Healthy people are what the Marketplace Insurer pools need.

 

[russelltw]

Allen,
I was told by an ins comp exec that healthy people might not be any value to the company. Reason being is if the member is classified as chronically ill (forget the term he used), the Feds give more subsidy for that person. That exec said his company did a poor job of classifying people in 2014.

Say two companies have 100,000 aca members each. Company A has 50% chronically ill. Company B has 20% chronically ill. Company A gets 19,0000 classified by doctors as chronically ill and Company B gets 19,000 classified as chronically ill. According to CMS, both have the same number of chronically ill and there is no addition money paid from Company B to Company A for having a sicker pool of people.

THis was explained to me in the Summer of 2015, with the money available through the risk corridors changing, who knows if this still applies.

 

[AllenChicago]

Russelltw, I heard something similar from our Blue Cross FMO. He said to send BCBS all the sick people we could find, because the Government set up ObamaCare to compensate companies that incur a lot of claims. This was at the start of the first Open Enrollment (2014).

But a lot has changed because the Feds are inserting SEP restrictions, due to health insurers complaining about too many claims coming from that group. I want to know why COBRA-eligible employees are considered a SEP time bomb.

EDIT: Nevermind. I found out why. A large number of people lose their job through being unable to work, being laid-off, or being fired, when they become physically or mentally ill.

 

[russelltw]

I thought that was what ACA was supposed to help??? Now you are not tied to your employer's insurance if you want to start your own business, etc, etc, etc.

 

[TN_agent]

I didn't read that as people HAVE to take COBRA and if they are COBRA eligible they aren't subsidy eligible ever.

Rather, I think that the marketplace allowed an SEP for people who were eligible for COBRA/enrolled in COBRA and wanted to move to the marketplace mid-year because they didn't know (or claimed that they didn't know/weren't informed) that opting out of COBRA within the 60 days was an option to get the subsidy, or they thought they could opt-out of COBRA any time and get on the marketplace.

I don't see the gummint forcing someone who just got laid off to take the $600 COBRA if their income is $20,000. It is bad publicity and bad for their enrollment numbers.

 

[Yagents]

I agree with TN agent, this was closing the Cobra "notification" loophole.

Lose your job, and income, and be forced to pay Cobra too?.........only a heartless republican would come up with that rule. And Dems never lose the chance to buy a voter.

 

[mwoodbrid]

I didn't read that as people HAVE to take COBRA and if they are COBRA eligible they aren't subsidy eligible ever.

Rather, I think that the marketplace allowed an SEP for people who were eligible for COBRA/enrolled in COBRA and wanted to move to the marketplace mid-year because they didn't know (or claimed that they didn't know/weren't informed) that opting out of COBRA within the 60 days was an option to get the subsidy, or they thought they could opt-out of COBRA any time and get on the marketplace.

I don't see the gummint forcing someone who just got laid off to take the $600 COBRA if their income is $20,000. It is bad publicity and bad for their enrollment numbers.

This is my understanding also. The loss-of-coverage SEP would still apply for folks being offered COBRA after losing/leaving a job, so they would still be able to enroll in Marketplace coverage.

 

[AllenChicago]

This is my understanding also. The loss-of-coverage SEP would still apply for folks being offered COBRA after losing/leaving a job, so they would still be able to enroll in Marketplace coverage.

Thanks to all who looked into this COBRA induced SEP, and found that the new restrictions will only affect very few people who lose their job. That's a relief!

Something that just occurred to me while mentally reviewing last year's SEP Enrollments. The Health Insurers I worked with did NOT ask for any kind of SEP proof with carrier-direct, non-exchange enrollees.

Why would they get mad at HHS-CMS for allowing too many "bad apples" to enroll at through Marketplace, while the carriers themselves didn't police their own Non-Marketplace SEP enrollments?

Also, I believe the vast majority of sick, injured, high-cost people who obtained health insurance outside of Open Enrollment, called HC.gov got the SEP, and were enrolled on the spot by the HC.gov employee. When they called me last year, I gave the HC.gov phone number, they got insurance, I became their agent after submitting an AOR. (4 out of 5 didn't last long though. Got medical treatment and cancelled the coverage.)

Since brokers enrolled very few high-cost SEP customers, cutting broker commission to stave off the sick enrollees, simply doesn't jibe. There are more sinister and selfish motives driving these cuts, IMO.

Starting this Monday 2.1.2016, it will be interesting to see the new SEP wording on HC.gov, and also learning if HC.gov employees have been restricted in their authority to hand out SEP enrollments to anyone who calls in with a good "story".