The Obama administration will tighten the rules for people who enroll in insurance through HealthCare.gov outside of official enrollment periods, hoping to hold down costs that insurers blamed on late sign-ups.
A top federal health official said Monday that the administration will eliminate some criteria for late sign-ups and make other criteria language clearer. Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, who made his comments during a J.P. Morgan health-care conference, didn’t provide further details.
Insurers say that the rules are so broad that people can wait until they get ill to buy insurance. That raises health-care spending and overall premiums because people who are sicker generally cost more to cover.
The steps are necessary, Mr. Slavitt said, because “bad actors” had been taking advantage of the existing rules and tightening them would ensure that the special enrollment period served its original purpose.
“It’s critical to enforce the integrity of the open enrollment period,” he said. He described earlier approaches as part of the administration’s own learning curve in implementing the health law and aimed at helping people adjust to it, too. The changes, he said, will ensure so-called special enrollment periods serve their intended purpose.
He also said the agency has created an enforcement task force to ensure that people are being honest, and said the task force has terminated coverage for some consumers who didn’t have legitimate reasons for enrolling outside the deadline.
Under the Affordable Care Act, people can buy coverage beyond the enrollment deadline under special circumstances including a marriage, divorce, job change or new baby. Last year, federal officials granted an extension to uninsured people who wanted to get health coverage at the same time they filed their taxes. Exceptions have also been made for people who faced technical problems using the federal government’s insurance website, HealthCare.gov, which serves about three dozen states.
Consumer groups, however, have pressed for additional exceptions that could allow more people—such as pregnant women—to gain coverage.
UnitedHealth Group Chief Executive Officer Stephen Hemsley mentioned concerns over the special enrollment period when announcing in November that his company expected to take a big hit from its insurance sales under the Affordable Care Act.
The Blue Cross Blue Shield Association in December wrote to Mr. Slavitt, saying the administration should reduce the 33 categories that qualify people to sign up after the deadline, which is known as “special enrollment.” It said officials should allow fewer special circumstances and require verification.
A Medicare program and the private market already have greater limits on special enrollment.
Nearly 950,000 new consumers selected a plan through the federal exchange, HealthCare.gov, outside the open enrollment period between Feb. 23 and June 30, 2015, federal officials said in August. The Obama administration has stressed that the robust sign-ups were a sign that there is demand for coverage and was further evidence the health law is working. About half obtained coverage after the enrollment deadline because they lost their health insurance.
The Obama administration has also provided additional reasons people could sign up past the deadline. Last year, the Obama administration offered uninsured people a reprieve if they missed the sign-up deadline for 2015 coverage, originally set at Feb. 15.
People were given through April to sign up if they said they had learned about the penalty for going uninsured only when they filed their taxes. The idea was to help people avoid a situation in which they were fined for going uninsured in 2014 and then learned they would face another fine for 2015—with no opportunity to remedy it.
Federal officials have already ruled out a similar reprieve for this year.
Mr. Slavitt also said the administration is ending a program that provides financial incentives to get health providers to use electronic health records to improve patient care. Instead, it is being replaced with a program that will focus on patient outcome based on the use of that technology.
Also Monday, Kentucky Gov. Matt Bevin took steps to start the process of ending the state-run exchanges to move to the federal exchange. The Republican had vowed to do so when campaigning.
The Health and Human Services said Monday that it is committed to work with the state on a seamless transition. They said the announcement by the state will have no impact on the current open enrollment. As of Sept. 30, there were about 87,000 residents with health coverage through Kentucky’s state exchange.