Most public discussion has centered on buying coverage through the exchanges. Exchange-plan sales end this month under special enrollment periods allowed by the federal and state exchanges to accommodate consumers who tried, but could not sign up before April 1 for various reasons.
After that, many people—even some experts—thought no further enrollment would be allowed, and that anyone who wanted health insurance would have to wait until the open enrollment period for 2015 coverage starts Nov. 15. The known exception is for those with qualifying life events such as losing job-based coverage, moving, getting married or divorced, or making more money and losing their Medicaid eligibility.
But the CMS issued a rule last year permitting insurers to continue offering Obamacare-compliant plans outside the exchanges after open enrollment ends. The catch is, no one knows any insurers that plan to do so. That's because under the Patient Protection and Affordable Care Act, insurers generally are barred from considering applicants' preexisting medical conditions or charging people more than the allowed three-to-one premium variation for comprehensive coverage, based solely on age.
“I do not expect many, if any, insurance companies to offer these policies outside of open enrollment,” said Sabrina Corlette, project director of Georgetown University Center on Health Insurance Reforms. “I would imagine they would view the risk of adverse selection to be too great.”
A spokesperson for the National Association of Insurance Commissioners said the NAIC was not aware of any insurers planning to sell plans after open enrollment ends.
UnitedHealthOne, a major carrier in the off-exchange individual insurance market, will sell ACA-compliant plans after open enrollment ends only if there is a qualifying life event, according a company spokeswoman.
Assurant, another prominent insurance carrier in the individual market, also said it will only offer ACA-compliant plans during open enrollment or if there is a qualifying life event. But that company will continue selling limited-benefit, non-compliant plans that do not offer comprehensive benefits, such as short-term and fixed-benefit products. Consumers buying these non-compliant plans could face Obamacare tax penalties for not obtaining qualifying coverage, a company spokeswoman said.
Hans Leida, an actuary with Milliman in Minneapolis, said it would be financially risky for insurers to sell plans after open enrollment ends, because they could attract people who sign up only when they need medical care, and insurers wouldn't be able to turn them away as they could before Obamacare took effect this year. “During open enrollment, insurers know all insurers are in the same boat,” Leida said. “But off open enrollment, you might be the only insurer accepting people.”
The only insurers that might be willing to take that gamble are those that proactively want to increase their market share or sign up more members to spread out their overhead costs, he said. If an insurer offered the exact same plan both inside and outside the exchange, it could qualify for federal risk-corridor payments to offset the costs of more expensive members. Still, Leida added, “it's a pretty risky proposition.”
“They'd basically have to decide to be their own private high-risk pool, and no insurer is going to do that,” said Tim Jost, a law professor at Washington and Lee University, who is an expert on the healthcare reform law.
Still, consumers who want to buy Obamacare-compliant coverage off the exchanges do have options in at least 14 states during the next few weeks. The insurance broker eHealth has identified more than 20 insurers that are selling plans in those states until the middle or end of April, even if customers have not experienced a qualifying life event.
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