Individual plans traditionally are available year-round, but insurers are now limiting their sale to enrollment periods that coincide with health insurance exchanges.
Conventionally, insurers have used open enrollments for employer-sponsored plans as a safeguard against financial losses. "The rationale is that you want to restrict the ability of people who wait until they get sick or need health insurance to buy it," Hans Leida, an actuary at consulting firm Milliman, told the Cincinnati Enquirer.
So if an insurer chooses to make plans available outside of the enrollment period, it would face "big risk" because unhealthy, expensive consumers would sign up in larger numbers for the only insurer offered, Leida added.
"These are the kinds of scenarios that insurers have to think about as they decide whether to offer coverage outside of open enrollment," he said. "It's really a balancing act to make sure people have access while making sure the system as a whole can function over time."
Although the Affordable Care Act lets insurers sell individual plans beyond the limited enrollment period--as long as they don't deny sick consumers--many aren't taking advantage of that opportunity.
In Ohio, for example, Anthem Blue Cross Blue Shield, Humana, UnitedHealth and Cincinnati-based HealthSpan will only sell individual policies outside of the enrollment period if consumers have a qualifying event, including marriage or birth of a child.
The same life-changing events make consumers eligible to sign up for exchange plans outside of open enrollment, FierceHealthPayer previously reported. Medicaid, meanwhile, has no enrollment deadline, so consumers eligible for the federal-state program can obtain coverage whenever they're interested.
To learn more:
- read the Cincinnati Enquirer article