Only about 15 percent of the consumers who bought individual major medical coverage through the HealthCare.gov exchanges this past spring used the confusion about the tax penalty on the uninsured to qualify for a special enrollment period (SEP) for major medical coverage.
About half of the consumers told HealthCare.gov they were applying for SEPs because they had lost other coverage. But the percentage of consumers who gave tax confusion as an excuse when they bought coverage in the spring was much higher in Southern states than in other states.
In Mississippi, for example, 2,932 SEP users, or 26 percent of all of the state’s SEP users, received a tax-season SEP. Tax-season SEPs also accounted for more than 15 percent of SEPs in Alabama, Arkansas, Florida, Georgia, Louisiana, North Carolina, South Carolina, Tennessee and Texas.
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Tax-season SEPs accounted for fewer 10 percent of SEPs in Delaware, Iowa, North Dakota, New Mexico, Ohio, Pennsylvania and Wisconsin.
The Centers for Medicare & Medicaid Services (CMS) has included figures on SEP justifications in a new batch of data on plan selection activity at the HealthCare.gov exchanges. The report covers the period from Feb. 23, when the 2015 open enrollment period officially ended, and June 30.
Regulators, exchanges and insurers set up the enrollment calendar system in an effort to keep consumers from using the new Patient Protection and Affordable Care Act (PPACA) limits on medical underwriting as a chance to wait to pay for health insurance only when they already know they are very sick.