The Obama administration said Wednesday it is taking steps to prevent misuse and abuse of special enrollment periods that allow Obamacare customers in 38 states to get covered on HealthCare.gov outside of the traditional signup period.
Over the next few months, the Health and Human Services Department will require customers to provide documentation of five life events that can trigger a special enrollment period (SEP) — marriage, a permanent move, a birth in the family, adoption of a child or the loss of Obamacare-compliant coverage from another source.
HHS said those life changes accounted for three quarters of requests to use a special enrollment period to enroll or changes plans in the second half of 2015.
“Consumers need to be sure to provide sufficient documentation,” the agency said. If they don’t respond to our notices, they could be found ineligible for their SEP and could lose their insurance.”
The announcement arrived hours after the Government Accountability Office said the administration is taking “a passive approach to identifying and preventing fraud” on Obamacare’s web exchanges.
Auditors said the federal data hub was unable to verify citizenship for 8 million applicants who claimed they were citizens in the 2014 plan year, nor could it track down critical information on things like income or family size for 30 million people.
The government needs that data before it doles out taxpayer subsidies that make coverage more affordable.
Meanwhile, insurers had asked the administration to tighten up the special enrollment process, saying customers who sought coverage outside of the normal process tended to be sick and rack up medical bills.
HHS said it will outline its new verification rules on HealthCare.gov and ratchet up language that requires customers to be truthful on their applications, or else risk penalties.
Obamacare’s regular enrollment period for 2016 lasted from Nov. 1 to Jan. 31, bringing in 12.7 million new and returning customers nationwide.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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