Washington state insurance regulators are bending the usual exchange plan enrollment period calendar to help victims of enrollment system and administrative system problems.
The first Patient Protection and Affordable Care Act (PPACA) individual coverage open enrollment period started Oct. 1, 2013, and straggled to an end in mid-April in most of the country. Federal regulators, state regulators, insurers and PPACA exchange managers came up with the calendar to try to keep consumers from using PPACA’s underwriting rules as a chance to wait until they get sick to pay for health coverage.
Consumers can get access to special enrollment periods (SEPs) for a variety of reasons, such as getting married, having a baby or moving to a different community.
Mike Kreidler, the Washington state insurance commissioner, says he will create a limited SEP in his state for Washington Healthplanfinder glitch victims. The SEP will last from Aug. 27 through Nov. 14 — the day before the regular open enrollment period for ordinary 2015 coverage starts.
“Only people who attest to having enrollment, billing, or payment issues with an exchange plan may change plans during this time,” officials say.
The insurers that sell individual qualified health plan (QHP) coverage through Washington Healthplanfinder can set their own requirements for consumers applying for a glitch SEP. “Most likely, they will ask you to attest or swear that you had a plan through the exchange but are having problems being able to use your coverage,” officials say in a batch of advice accompanying the announcement. “Some insurers may ask you for additional information,” they added.
Washington state had a relatively smoothly running exchange, but about 10 percent of the QHP buyers seem to be having lingering enrollment, billing or payment problems, Kreidler says in a statement.
Consumers who use the glitch SEP can either keep their current QHP or switch to another QHP at the same metal level.
Consumers can also buy coverage outside the exchange. About 85 percent of the exchange QHP buyers have premium subsidies, and consumers who getting federal premium or cost-sharing reduction subsidies cannot use those subsidies with off-exchange plans, officials say.
Kreidler says he supports the exchange.
“They are dedicated to solving these technical issues, and they are making progress,” Kreidler said. “But, as insurance commissioner, it’s my responsibility to do what I can to give consumers as many options as possible for getting coverage.”