Obama Administration Announces More Flexibility With ACA Coverage

The Obama administration will allow consumers who purchased health plans through HealthCare.gov to select a new plan of the same coverage level before March 31 if their plan's network does not include their physicians, according to a CMS memo sent to insurers last week, the Washington Post reports (Goldstein, Washington Post, 2/7).

The Obama administration last week came under fire after the Washington Post reported that tens of thousands of formal appeals to CMS for help to resolve issues U.S. residents experienced while enrolling in coverage are still pending.

According to the Post, internal government data show about 22,000 U.S. residents have mailed appeals forms contending that they were overcharged for premiums, enrolled in the wrong coverage or denied coverage. The parts of the federal computer system that would allow agency workers to read and handle the appeals have not yet been built, according to sources familiar with the situation (California Healthline, 2/4).

The memo, which was obtained by the Post, says that consumers will be allowed to make changes to their coverage before the end of the open enrollment period on March 31 if they want to "move to a plan with a more inclusive provider network" or qualify for "other isolated circumstances." Specifically, the memo states that those who switch plans for provider network reasons must choose a plan from the same insurer and tier of coverage.

The memo also noted that an individual could qualify for special enrollment periods beyond the March 31 deadline if they can prove HealthCare.gov incorrectly displayed coverage details for a chosen plan or they experienced issues enrolling in coverage through the federal website.

According to the memo, HealthCare.gov also has a new feature -- called "Report a Life Change" -- where an individual could qualify for additional enrollment time to enroll in coverage if they experienced a change in circumstances, such as a:

• New baby or family member;
• Death in the family;
• Move; and
• Release from prison (Washington Post, 2/7).

The memo also described a new online function that allows enrollees to cancel their coverage as soon as 14 days after submitting the request. However, those who cancel their plans would be unable to purchase coverage beyond the March 31 deadline unless they qualified for one of the described special exemptions. The next open enrollment period is scheduled to begin Nov. 15.

Meanwhile, individuals who refuse to pay their first month's premiums also could have their coverage canceled by insurers, enabling them to create a new account and purchase a new plan, according to the memo (Adams, CQ HealthBeat, 2/7).

Reaction

CMS spokesperson Aaron Albright said, "We added this new flexibility, recognizing that many consumers are using a new system and getting coverage for the first time."

However, Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said the change is limiting. She noted that most U.S. residents can switch to plans offered by any insurer during an open enrollment period, not just plans from the same insurer (Washington Post, 2/7).