CMS Outlines Pre-Enrollment SEP Verification Process, Reaches Out To Those In Both Medicare And Marketplaces

The Centers for Medicare and Medicaid Services has released a slide deck describing in greater detail the process that they intend to use for pre-enrollment verification of special enrollment period (SEP) eligibility. CMS has also begun sending out Medicare periodic data matching notices to consumers enrolled in both Medicare and a marketplace plan, but those notices may be misleading. How CMS Will Verify Pre-Enrollment Eligibility For Special Enrollment Periods On June 23, 2017, pre-enrollment verification will begin for new applicants (not already enrolled in marketplace coverage) who claim SEPs for loss of minimum essential coverage or for a permanent move. (Existing marketplace enrollees who attest to a SEP qualifying event are not subject to pre-enrollment verification). In August, pre-enrollment verification will begin for people who claims SEP eligibility for marriage; gaining or losing a dependent through adoption, adoption placement, foster care placement, or a child support or other court order; or Medicaid or CHIP denial. The slides focus on the loss of coverage and permanent move SEPs. An application for a SEP subject to pre-enrollment verification will create a SEP verification issue or SVI. If consumers attest to more than one SEP qualifying event on a single application, only one SEP will generate an SVI. If multiple household members on one application are all subject to the same loss of coverage or move, their application will also only generate one SVI. If a...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage special enrollment periods Source Type: blogs