insurance open enrollment

CMS looks ahead to 2017 open enrollment

Healthcare leaders have now had a chance to evaluate the most recent open enrollment period and identify steps for improving next year’s processes. While the general trends show that consumers are getting the hang of using insurance exchanges, advocates continue to push for greater transparency and more features that will make it easier to comparison shop. Meanwhile, some payers’ wishes have been granted, with greater enforcement of special enrollment eligibility, and CMS stopping short of requiring standardized exchange offerings.

  • New documentation required for special enrollment

As mentioned in an earlier blog post, CMS has announced that it will work harder to ensure that only qualified buyers are able to purchase policies outside of open enrollment. The agency has now provided further details about how that will happen, with customers being required to provide documentation for the key events that qualify them for special enrollment, including:

  • Loss of minimum essential coverage
  • Permanent move
  • Birth
  • Adoption, placement for adoption, placement for foster care or child support or other court order
  • Marriage

CMS states that these situations accounted for three-fourths of customers who enrolled in a plan or changed from one plan to another from July through December 2015.

  • More customers shopping wisely

Anna Filipic, president of Enroll America, which aims to help consumers enroll in coverage via the marketplaces, has also reflected on the most recent season’s successes and challenges, noting that 4 million new customers enrolled this year. Among this year’s pool of re-enrollees, she states that 70 percent “took action to stay covered, even though they could have stayed on autopilot and had their insurance renewed automatically.”

Filipic concludes that this, coupled with the fact that more people bought policies in advance of the December 15 deadline, “tells us consumers are getting more engaged and more familiar with the process of starting the year with coverage.”

  • CMS encourages—but doesn’t require—plan standardization

One continuing challenge pointed out by Filipic is the need to make it easier for people to choose the best plan for them. On this point, CMS has released a set of standardized options for plans, outlining, for example, that all offerings within a category (i.e., Bronze, Silver, Gold and Platinum tiers) should have the same annual deductible. While an earlier proposal required payers to provide these standardized options, the plan was scaled back after payers reacted negatively, and the final rule lets payers choose to participate.

For now, CMS has also backed off a proposal to require all ACA plans to meet standards for having in-network doctors and hospitals within certain distances of members. The National Association of Insurance Commissioners has proposed its own state-by-state plan for these standards, and CMS has agreed to give states a chance to implement those measures, but also said that it would revisit the issue in the future.

Finally, the agency has reminded all stakeholders that open enrollment will again run from November 1 this year through January 31, 2017. Look for more tips from ABILITY Network about how your organization can prepare for patients’ payer changes and optimize your eligibility-checking processes.