The New Special Enrollment Confirmation Process

CMS BLOG

https://blog.cms.gov/2016/02/24/the-new-special-enrollment-confirmation-process/

 

February 24, 2016
By: Kevin Counihan, Health Insurance Marketplace CEO and Shantanu Agrawal, M.D., CMS Deputy Administrator and Director, Center for Program Integrity

 

The New Special Enrollment Confirmation Process

At the end of January, we concluded our third Marketplace Open Enrollment Period with 12.7 million people enrolling in coverage nationwide – more than ever before. In addition, about 400,000 people are signed up on the New York and Minnesota Marketplaces for coverage through the Basic Health Program. Open Enrollment exceeded our expectations – four million new people enrolled in just the HealthCare.gov states alone, 60 percent of our new enrollees signed up before the January 1 coverage deadline, and 70 percent of returning consumers actively re-enrolled. Marketplace coverage is a product people want and need.

As the Marketplace continues to grow and mature, we continue to monitor the health of the Marketplace and are looking for ways to make improvements – whether that’s creating new decision support tools to help consumers choose the right plan, strengthening risk adjustment, or clarifying the rules of the road for special enrollment periods, as we did several weeks ago.

Today, we are announcing another step that will enhance program integrity and contribute to a stable rate environment and affordability for consumers: a new Special Enrollment Confirmation Process in the 38 states using the HealthCare.gov platform. Under the new process, all consumers applying through the most common special enrollment periods will need to submit documentation to verify their eligibly to use an SEP. This represents a major overhaul of the SEP process. You can read more about the Special Enrollment Confirmation Process here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-24.html

Special enrollment periods are an important way to make sure that people who lose health insurance during the year or who experience qualifying life changes have the opportunity to enroll in coverage. We are committed to making sure that special enrollment periods are available to those who are eligible for them. But it’s equally important to avoid misuse or abuse of special enrollment periods.

This change in HealthCare.gov’s special enrollment period process does not restrict anyone's access to a special enrollment period who is rightfully able to enroll in coverage. But consumers will need to be sure to provide sufficient documentation to establish their eligibility. If an individual doesn’t respond to our notices, they could be found ineligible to enroll in Marketplace coverage and could lose their insurance.

As we begin work to implement the new process, CMS will solicit feedback from consumer advocates, insurers and other stakeholders over the next few weeks on verification requirements, processes and acceptable documentation. We welcome feedback and suggestions, which can be sent to SEP@cms.hhs.gov

As we head into the third year of Marketplace coverage, we are pleased with the results of Open Enrollment and confident that the Marketplace will continue to thrive for years ahead. Making sure that the rules around special enrollment periods are clear and enforced is just one step we are taking to help make sure that consumers and insurers will continue to benefit from an attractive, competitive and growing Marketplace.