explanade
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UnitedHealth suggests Obamacare is being gamed - MarketWatch
And even suggested that people are gaming the plans by enrolling for special enrollment periods and then submitting claims:
However, some are skeptical that UNH is being victimized by people enrolling just before they use medical services:
It seems insurers stop offering plans on the exchanges but they still try to get people to sign up for plans outside the exchanges. Presumably these are still ACA-compliant but not eligible for subsidies?
And even suggested that people are gaming the plans by enrolling for special enrollment periods and then submitting claims:
In a profit warning that sent its stock down as much as 7% Thursday, UnitedHealth Group Inc. said that not enough people are signing up under the exchanges set up by Obamacare and that it was considering withdrawing from them.
But there was another factor behind the lowered outlook from the nation’s biggest health insurer: people signing up after the open-enrollment period that have higher claims. Or, less charitably—people are gaming Obamacare.
In UnitedHealth’s UNH, -0.25% words: “We have identified higher levels of individuals coming in and out of the exchange system to use medical services.”
This isn’t supposed to happen. There are so-called special enrollment periods, meant to be 60 days following certain life events—marriage, birth of a child, or a loss of health coverage.
Other special periods include moving, gaining citizenship, gaining or losing a dependent, having a change in income or household status that impacts eligibility for tax credits or cost-sharing reductions, and leaving jail.
A spokesman for UnitedHealth acknowledged the issue but didn’t provide more details on how this was occurring or what medical services these out-of-enrollment users sought.
However, some are skeptical that UNH is being victimized by people enrolling just before they use medical services:
Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation, said other insurers haven’t voiced these concerns. She says that it could be the group who takes advantage of special enrollment are more likely to want medical coverage.
“The penalty is the stick that motivates people,” Cox said. “If you don’t sign up for coverage in a short window, not only do you have to pay a penalty, you wouldn’t be able to sign up for another year.”
“Because special enrollment provides an exception to the latter part of the stick, it could be people that want to sign up want that coverage.”
Cox also pointed out that UnitedHealth, after skipping the exchanges the first year, was one of the lowest-cost providers, meaning that it was more susceptible to being pressured on profitability.
It seems insurers stop offering plans on the exchanges but they still try to get people to sign up for plans outside the exchanges. Presumably these are still ACA-compliant but not eligible for subsidies?