The White House is taking new steps to appease Obamacare insurers who are having trouble reaching profitability in the law’s marketplaces.
The Centers for Medicare and Medicaid Services made it harder for an Obamacare customer to apply for certain special enrollment periods and changed rules overseeing taxpayer-funded consumer operated and oriented plans.
The moves come as insurers are listing problems reaching profitability in Obamacare’s marketplaces. Some major insurers — UnitedHealth and Humana — recently announced they are exiting some states due to financial problems.
Major insurers have called for changes to the special enrollment periods in order to stabilize the marketplaces.
The co-ops have also fallen on hard times. So far 12 of the 23 taxpayer-funded plans closed. A big reason was a lack of federal funding from a program intended to help insurers mitigate losses in Obamacare markets.
CMS will attempt to pare down the number of special enrollment periods in the law. A special enrollment period allows an Obamacare enrollee to sign up for the law year-round instead of during the normal open enrollment period.
When Obamacare first was implemented back in 2014, it included more than a dozen special enrollment periods. These periods include whether you just got out of jail, got divorced or married or lost your job and work-based insurance.
However, insurers were seeing some people sign up for Obamacare when they got sick and just dropping out, raising costs for the insurer.
So the administration earlier this year cut some of the special enrollment periods, such as whether someone was confused by signing up for Obamcare.
Now the administration announced Friday it will clarify that “special enrollment periods are only available in six defined and limited types of circumstances,” said CMS spokesman Aaron Albright.
Those types of circumstances are losing other insurance coverage, a birth or marriage, a permanent move, need for financial help, errors made in a marketplace plan or other cases such as cycling between Medicaid and the marketplace coverage.
A significant change is to the special enrollment period for a permanent move. An interim rule says that individuals who want a special enrollment period because they moved must have minimum essential healthcare coverage for one or more days in the 60 days before that move, according to a CMS fact sheet.
“This ensures that individuals are not moving for the sole purpose of obtaining health coverage outside of the open enrollment period,” CMS said.
CMS also said it changed several rules for co-ops to help ensure their financial stability.
“The rules make several changes to board composition, and provides clarification on the rules governing market offerings,” Albright said.
