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Life Health > Health Insurance > Health Insurance

'Special' health sales a mystery

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Agents and brokers are still trying to figure out how many consumers can and will buy their own health coverage during the new individual market nap period.

The official open enrollment period for individual “qualified health plan” coverage began Oct. 1 and ended March 31. Broad individual QHP enrollment period extensions ended in most of the country in mid-April. 

The U.S. Department of Health and Human Services has not released any QHP enrollment figures for the exchanges it runs since the end of the open enrollment period, and some observers say it may not release new QHP enrollment figures until the 2015 open enrollment period begins.

In Minnesota, QHP enrollment increased by only about 55 people per week between April 27 and May 11.

Nap period enrollment activity was far below the overall average of about 1,800 per week.

In Maryland, QHP enrollment increased by about 500 per week, compared with an open enrollment period average of about 2,400 per week.

In Washington state, QHP enrollment increased by about 5,000 per week between mid-April and mid-May. The open enrollment period average was about 6,000 per week.

Regulators developed the enrollment period system in an effort to keep the new Patient Protection and Affordable Care Act underwriting limits from encouraging consumers to wait until they get sick to buy coverage.

Insurers appear to be using the enrollment period calendar for off-exchange individual products as well for exchange plans.

Consumers who want to buy individual or family coverage now can qualify for a 60-day special enrollment period if they can show the meet one of many different requirements. Some of factors that could help a consumer qualify for a SEP include moving, changing jobs, losing access to group coverage, or suffering from misinformation provided by a broker or navigator.

Michael Bertrand, a former Vermont insurance commissioner who is now the head of government relations at the iCan Group — a large health insurance products distributor, said he thinks about 10 percent to 20 percent of the consumers shopping for individual or group coverage can qualify for SEPs.

His company sells short-term medical insurance, which does not have to comply with the underwriting and pricing requirements that apply to major medical coverage. Short-term medical is still readily available, even during the quiet period.

Some consumer groups have suggested that competition from “excepted benefits” like short-term medical and hospital indemnity insurance could hurt the major medical market, by siphoning healthier consumers away from the major medical market.

Bertrand said he hopes regulators will leave room for insurers to continue to sell those products, especially during the individual market nap period.

“Wouldn’t they rather people have some kind of coverage?” Bertrand asked.

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