ABILITY Partner Community

Questions about ACA’s future don’t change current open enrollment needs

While the outcome of the presidential election has thrown the future of the Affordable Care Act into question, early predictions are that if replacement legislation is enacted, it won’t go into effect until two years from now. The upshot is that the annual process of open enrollment will continue for the time being on Healthcare.gov and state exchanges, just as it will for Medicare and employer-sponsored plans.

That means for healthcare providers, the open enrollment game will remain unchanged for the time being – so now is the time to take steps to ensure that patients’ payer changes don’t go unnoticed in January. There are many reasons that patients may forget to inform providers about their plan changes (more on that in our flipbook, Open Enrollment: Are You Ready?) but regardless of the reason, the outcome is the same – delayed and denied claims that impact your bottom line.

This year, the Department of Health and Human Services has estimated that 13.8 million people will use the ACA exchanges to sign up for coverage, an increase of 9% over last year. That pales next to the 175 million people who have employment-based coverage, as well as the 62 million on Medicaid and 51 million on Medicare. So while there is significant uncertainty in one segment of the insurance market, the vast majority of patients are covered by other plans – which nonetheless still need reconfirmation from year to year and visit to visit.

The most efficient way to confirm eligibility varies from provider to provider, and depends on the type of treatment provided, but ABILITY has options that allow for one-time or recurring batch eligibility checks for all payers, as well as ongoing monitoring of Medicare coverage. To learn more, visit the Open Enrollment section on our Resource Center, or contact us to discuss your individual needs.