The Trump administration has announced new Affordable Care Act (ACA) rules for individuals and employers for this fall open enrollment and for the health insurance plans next year.
1. As of now, the ACA open enrollment period will start on November 1st and end on December 15th. This is substantially shorter than the most recent open enrollment period. The intention seems to be to provide a standard 12- month policy period for everyone, and shore up complexities in processing insurance plans that could have a 1/1, 2/1, or a 3/1 effective date.
2. Anyone who signs up for health insurance outside of the open enrollment period, will have to provide specific and verifiable proof of eligibility to enroll based on a qualifying life event. In the years before the ACA this was always the case, and is a reasonable requirement. The intention to return to this protocol is to eliminate the opportunity to “game the system” and for people to obtain coverage when they were not actually eligible to do so. In many cases, over the years, expensive medical procedures and treatments were covered for some of these people, but then they stopped paying premiums and cancelled their plans as soon as the coverage was not needed for those procedures and treatments. This ultimately affects everybody’s premiums.
3. The administration’s new ACA rule allows insurers to refuse to cover a person who hasn’t paid their premiums. The insurance companies will have to apply this to all employers or individuals. Supposedly some state laws will have to change regarding this rule. Also, this rule will apparently not be applied to employer plans sold on the federal small business SHOP marketplace due to “operational constraints,” according to the information available.
Regardless, Evansville Insurance Center deems this to be creating an uneven playing field. The problems with SHOP enforcement of this rule should be resolved before it is a rule levied on all other insurance plans.
4. Health plans will also get more flexibility in creating products to sell in their market- and not be restricted to the bronze, silver, gold, and platinum Qualified Health Plan benefit designs that were required by ACA rules. This is the great news! Insurance companies should now be able to design health insurance plans that are more suited to the particular people they are intended to cover. Hopefully this new rule will be the mark that we are on the way to good changes.
Source: Virgil Dickson, Modern Healthcare.