Aetna CEO Mark Bertolini said Monday that he has serious concerns about whether the ACA health insurance exchanges are sustainable, echoing remarks from other top insurers such as UnitedHealthcare and Humana. He softened the news by stating it was “way too early to call it quits on the ACA and on the exchanges” because they offered a “big opportunity”. Much of the concern from Aetna, BlueCross, UnitedHealthcare and other providers stems from people signing up outside of the ACA’s annual enrollment window, and requiring a lot of care.
At face value, people signing up after a life event is a good thing since it allows them to enroll or upgrade their coverage (this is called a Special Enrollment Period or SEP). The expectation is they will keep their newly acquired or upgraded coverage to help offset their unanticipated entry into the insurance pool. Things get difficult for the carriers when people sign up for coverage (due to a life event), utilize their benefits heavily, and then drop the plan once they are healthy. Aetna’s Chief Financial Officer Shawn Guertin went right to the heart of their concern by stating, “insurance systems tend to get stressed when people can buy coverage when they know they need it and then drop it when they know they don’t”.
But don’t abandon all hope yet. Federal officials announced last month that they would end several narrow special enrollment windows that focused on consumers like non-citizens with incomes below the federal poverty level who experienced processing delays. The carriers have also approached government officials asking for clarification on the remaining guidelines, in an effort to foster a ‘meet in the middle’ type attitude. These talks include whether a temporary move would trigger a SEP, or if people who don’t provide accurate information on their applications could be penalized.
So where does this leave us? For now, it’s business as usual. Since we’re out of the standard open enrollment period, customers can still buy coverage if they are in a special enrollment period (SEP).
If you don’t qualify for the SEP you still have a few choices: