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HHS Tightens Health Insurance Marketplace Rules

The U.S. Department of Health and Human Services (HHS) is tightening rules for health insurance marketplaces to increase both enrollment and stability.

Beginning June 17, individuals signing up for coverage outside of the open enrollment period must provide documentation proving they are eligible for a Special Enrollment Period. This builds on recent efforts by the administration to close loopholes that allowed individuals to sign up for coverage outside the open enrollment period.

HHS also has announced it will propose an amendment to the risk adjustment methodology for marketplaces insurers. Specifically, HHS seeks greater risk pool stability for insurers that attract a disproportionate level of sick beneficiaries. Beginning in 2017, the methodology will account for partial-year enrollees. In 2018, the methodology will include prescription drug data. HHS will propose these changes in future rule making.

Contact Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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