The downside of tightening special enrollment period rules

Though health insurers have pressured the government to tighten its rules governing the Affordable Care Act's special enrollment periods (SEPs), doing so may not be in the best interests of consumers or health plans.

As senior policy analyst Sarah Lueck writes in a blog post for the Center on Budget and Policy Priorities, past research has found that fewer than 15 percent of people who are eligible for SEPs actually use them to enroll in health coverage when they experience a qualifying life event such as changing jobs or getting married.

Insurers have made it clear that those individuals who do enroll during SEPs tend to generate higher medical claims costs than the average enrollee, and also stay in plans for shorter amounts of time. In fact, UnitedHealth cited high costs associated with SEP enrollees in its recent announcement that it may exit the ACA exchanges in 2017.

Those who use SEPs are probably high utilizers because they are the ones who most need healthcare services, Lueck writes, arguing this highlights the fact that awareness of the special signup periods is actually very low among the general population.

In response to insurers' concerns, the Centers for Medicare & Medicaid Services said it will end some SEPs and step up its oversight to ensure that those who enroll during these periods are actually eligible. But to Lueck, this is not a wise approach.

"For millions of uninsured people who would be eligible to enroll in marketplace coverage each year--as well as the overall risk pool--bending further to insurers' pressure would be the wrong prescription," she writes.

It's also not particularly helpful to insurers, either, she adds, as tightening SEP rules could deter healthy people from enrolling in ACA plans when they experience a qualifying life event, thus damaging the overall risk pool. So rather than focusing on changing the regulations, Lueck writes, insurers instead should strive to educate consumers about SEPs.

To learn more:
- here's the blog post

Related Articles:
CMS outlines changes to special enrollment period rules
Special enrollment periods costly and open to abuse, insurers warn
UnitedHealth's exchange exit threat: What it means
Special enrollment periods offer consumer-outreach opportunity

Read more on