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December 13, 2016 at 12:36 PM
HealthCare.gov managers say they hope to test a new strategy for screening people who apply for individual major medical coverage outside the normal enrollment period.
Related: New exchange screening rules slash sales
Starting in June, HealthCare.gov will require half of the people who are asking for special enrollment periods to provide documentation showing that they qualify for it, according to a new fact sheet on the Centers for Medicare & Medicaid Services (CMS) website.
The affected consumers will have to send in the documentation, through HealthCare.gov or through regular mail, before their exchange plan coverage will start.
Consumers who fail to submit documentation within 30 days may lose access to exchange plan coverage.
CMS, the arm of the U.S. Department of Health and Human Services that runs HealthCare.gov, says it wants to use a random process to put half of special enrollment period applicants in all markets it serves into the pilot program.
CMS will evaluate the effects of the pilot program throughout 2017, and it will conduct more evaluations in the spring of 2018, officials say.
CMS started HealthCare.gov to provide Affordable Care Act exchange services in states that were unable or unwilling to provide the services themselves. The pilot program would operate only in the states HealthCare.gov serves.
The ACA now requires insurers to sell and price individual major coverage without use of information about people’s health. They must charge the same price for people who are healthy and for people who are about to get lung transplants.
ACA exchange programs, insurance regulators and insurers developed the current open enrollment period system, or limits on when people can buy individual major medical coverage, to keep consumers from seeing the new restrictions on medical underwriting as a chance to wait until they get sick to pay for coverage.
