Changes from 2015 to 2016... Rules, Premiums, Plans, Exchanges, Etc.

[Tkruger]

But consumers will need to be sure to provide sufficient documentation to establish their eligibility,” he said. “If an individual doesn’t respond to our notices, they could be found ineligible to enroll in Marketplace coverage and could lose their insurance.”

This new rule (Feb 24th) doesn't prevent initial SEP's from being granted and does nothing to keep those who should have enrolled during OE from gaming the system by getting coverage when they are diagnosed with an illness.

Also what does this rule do for those who pick up coverage crying SEP just to have a procedure done and then to drop the coverage willfully or by Marketplace termination?

 

[RayNY]

Tkruger,

As far as I know, it does nothing to stop that.

Right now, most of the risk is put on carriers, who in theory, are protected by the government's "three R's".

The alternative is a retro term to enrollment for those who don't prove eligibility, with all claims denied and sent to the former policyholder.

Realistically, they won't pay. Providers will have to spend their own time/money tracking down individual debtors, just to have them refuse to pay, putting all of the risk on the providers.

 

[HealthRisk]

Tkruger,

As far as I know, it does nothing to stop that.

Right now, most of the risk is put on carriers, who in theory, are protected by the government's "three R's".

The alternative is a retro term to enrollment for those who don't prove eligibility, with all claims denied and sent to the former policyholder.

Realistically, they won't pay. Providers will have to spend their own time/money tracking down individual debtors, just to have them refuse to pay, putting all of the risk on the providers.

And two of those R's disappear in 9 months.