posted by AHIP/BlueCross BlueShield Association
on February 10, 2016
Expanding access to health insurance has been a defining goal of the new insurance marketplaces. To ensure a stable, affordable market for all consumers, it is important that everyone obtain and maintain continuous coverage. This is also central to efforts to transform our health care system by rewarding value over volume, improving care coordination, and focusing on prevention and slowing disease progression.
Special enrollment periods have long played a key role in promoting continuity of coverage during important life transitions, such as job changes, relocations, marriage, and births. In the employer market and under Medicare, health plans ensure the appropriate use of special enrollment periods by verifying an applicant’s eligibility to enroll. In contrast, current rules of the federal Exchange market allow people to enter the marketplace through special enrollment periods without proof of eligibility or evidence of prior coverage. As a result, individuals may purchase health insurance only when they need medical care and then drop coverage after receiving the services they need. This misuse of special enrollment periods threatens the long-term affordability and stability of the Exchange market.