When Life Gets Complicated, Signing Up for Health Insurance Should Stay Simple

By Sophie Stern

If you’re losing your job, moving to a different neighborhood, or starting a new family, you’ve got a lot on your mind. Fortunately, under the Affordable Care Act, health insurance can be one less thing to worry about.

That’s because “Special Enrollment Periods” (SEPs) are available year-round for people going through life changes to get quality, affordable coverage in the health insurance marketplaces.

Right now, the Department of Health and Human Services is in the process of implementing new SEP documentation requirements for consumers. These new requirements will aim to ensure that SEPs are made available only to individuals that are eligible to access coverage outside of the traditional open enrollment period (November 1 – January 31). At Enroll America, we share the goal of limiting abuse of SEPs. Traditional enrollment periods exist for a legitimate reason — to help protect against moral hazard and keep costs down.

This being said, we believe that placing undue verification or documentation burdens on consumers — particularly in the absence of evidence that SEPs are being abused or granted to individuals who do not legitimately qualify — may actually prevent eligible people from enrolling.

By following a framework of consumer-friendly principles, including these laid out below, policymakers can minimize the burden on consumers and help maximize the number of eligible people who sign up, while also maintaining the integrity of the system:

  • First and foremost, policymakers should limit the amount of paperwork people have to submit to the marketplace; and new requirements should not result in unnecessary gaps in coverage due to the lack of easily accessible proof for many triggering events. If proof of a qualifying life event already exists — such as an insurance claim filed after the birth of a child — then parents shouldn’t have to submit additional documentation to prove what’s already been verified.
  • The process for how to submit documentation, should it be necessary, and any next steps required of the consumer should be crystal clear.
  • One central, unbiased authority — the health insurance marketplace — should continue to have the final say in determining who’s eligible.
  • HHS should ensure that the appropriate IT systems and infrastructure are in place to manage how they collect and verify documents in a way that streamlines the process for consumers.
  • Finally, we know that in-person assistance is critical for consumers; therefore, assisters and call center staff should be trained on the types of documentation required and the mechanisms consumers can use to send or upload information. Furthermore, call center staff should be able to provide consumers with the information they need, based on the documentation they’ve submitted and their household’s situation, to navigate the marketplace and connect to coverage if eligible.

And at the same that these consumer-friendly protections should be put in place to prevent people from falling through the cracks, smart partnerships can be developed — such as teaming up with hospitals that send health insurance information home with new families, job-placement organizations who work with people who have lost employer-based coverage, and utilities who can notify new residents of their options — to help get the right SEP-eligible consumers the information they need at exactly the right time, and make it easier for them to find out how to get covered.

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