Consumers underestimate health plan decision making


Hardship exemptions aren't clear enough for consumers to take a chance on special enrollment period

The Department of Health and Human Services (HHS) is keeping the door open for consumers who want to enroll in healthcare coverage, according to Michael Mahoney, senior vice president of marketing for GoHealth, an online broker that was federally approved to sell subsidized plans in 36 states.

“If there are a million people out there that don’t want to enroll, I don’t think HHS is going to be too incentivized to extend a deadline or provide some alternative for those folks,” Mahoney says. “However, if there are a million people who didn’t get the message or didn’t understand the deadline applied to them, if they still want to enroll, that’s a different scenario.”

HHS provided guidance earlier this week on the types of extenuating circumstances it will forgive for consumers who miss the March 31 open-enrollment deadline. For example, a consumer that experiences a hurricane and doesn’t get around to signing up for coverage will be permitted to enroll late, although HHS isn't specifying how late. Ten circumstances are outlined by HHS, but Mahoney says many of them are nebulous.

“If you have unpaid medical bills in the past six months, which is one of the hardship exemptions, does that mean you just didn’t see them or you couldn’t pay them?” he says.

Brokers are having a difficult time providing advice to consumers because the exemptions are unclear and there hasn’t been any follow up from HHS to better define how it’s going to react. Instead, GoHealth is cautioning consumers to sign up as soon as they can and not take the risk.

Consumers Misinformed

Mahoney has seen a trend of consumers who are still misinformed and believe, for example, only those with subsidies have a March 31 deadline. When they discover the deadline does apply to them, some are finding that deciding on a plan is more involved than anticipated, especially for families with a variety of health needs.

HHS is anticipating that the final days of open enrollment will drive a surge in online applications and call center activity. If a consumer experiences a technical difficulty or a long wait time to process their application, he or she will be granted an extended deadline. However, if the consumer is simply putting off the decision and fails to begin the enrollment process, federal officials don’t have the authority to extend the deadline.

In recent days, the population of enrollees signing up through GoHealth has not only increased 10 times or more compared to January, but the demographics have shifted, too. Families, older people and sicker people signed up for health coverage early on, as expected, while more individuals and younger people are enrolling now, Mahoney says.

“In January, we had a lot of people researching their health insurance options, knowing they still had time to make a decision,” he says. “What we’re seeing now is pure sign ups.”

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