Tuesday, January 12, 2016

Enrollees Gaming Obamacare Drive Claim Costs Through the Roof

Enroll when you get sick and then drop coverage

The New York Times is reporting that the Obama administration has created more than 30 “special enrollment” categories allowing folks to enroll in Obamacare outside of a normal enrollment period.  That has allowed people to wait until they become ill or need medical services to sign up, driving up costs significantly.

Individuals enrolled through these special enrollment periods are utilizing up to 55 percent more services than their open enrollment counterparts.

It leaves individuals with no incentive to enroll in coverage during open enrollment as most can simply wait until they are sick or need services before enrolling and drop coverage immediately after receiving services.

And some of these special enrollment qualifiers are far less than ironclad.  Consumers may, for example, be eligible for a special enrollment period in “exceptional circumstances” and in “other situations determined appropriate” by the Centers for Medicare and Medicaid Services. The circumstances may include “a serious medical condition” or “misinformation” about a healthcare plan that interfered with normal plan enrollment.

Full story from NYT.