Obama Administration Moves to Help Insurers Cover Sick Enrollees


One of the biggest problems with Obamacare is the fact that more sick people signed up for coverage under the law than was expected.

That’s ironic since providing coverage for people with pre-existing conditions was a major reason for enacting the Affordable Care Act. But high benefit requirements and other mandates led to high premiums, and too many young, healthy people have stayed away from the ACA exchanges.

Helping insurers manage the risk of covering sick enrollees is a top focus of a Department of Health and Human Services rule governing the exchanges.

For instance, a pilot program that begins in 2017 requires people who sign up for coverage outside of normal enrollment periods to document that they are eligible to do so because of life changes such as marriage, having a child or moving. Insurers argue that claims for people who enroll up during so-called special enrollment periods are higher than for other enrollees, and they have called for more verification of eligibility.

Another provision will force dialysis facilities to disclose the risks of different coverage options to their patients. Some dialysis facilities were steering Medicare- and Medicaid-eligible patients to exchange coverage that wasn’t in the patients’ best interest, but which reimbursed medical providers at rates as much as $100,000 to $200,000 more per patient per year, the HHS said.

Changes were made to the ACA’s risk adjustment rule, under which insurers that cover healthier populations must make payments to insurers that cover sicker groups. Small, new plans have had to make big payments under the rule to big, established carriers that have a longer claims history for their enrollees.

Read the full story at https://www.bna.com/hhs-moves-help-n73014448798/.

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