Monday, December 16, 2013

Gaming the system: We *may* have a winner

Last month, FoIB Dr Stuart Fickler posed a challenge:

"It appears to me that a system as complex as Obamacare is vulnerable to a vast range of gaming.  To be clear, I am not referring to just the computer aspects of the system, but the entire system, from applying to delivery of the care itself ...  if they don't want to take the risk of "second class medical treatment", they can switch over to the "marketplace" insurance."

I was skeptical that this would be a viable strategy, asking "what if the diagnosis came, and treatment was scheduled to begin, between regularly scheduled Open Enrollment periods?" There was also the challenge in finding a suitable "Special Open Enrollment period [SOE]."

While perusing another blog, I noticed that someone observed that simply moving to another state would be sufficient to trigger such an event. Again skeptical, I began researching to see if this might be the elusive "viable strategy."

And it appears that it just may be. According to Ms Shecantbeserious:

"Outside open enrollment, you can enroll in a private insurance plan through the Marketplace only if you have certain life events that give you a special enrollment period ... "Permanently moving to a new area that offers different health plan options"

Now this would seem to indicate that a SOE period is triggered simply by moving to (for example) a different state (notwithstanding the difficulties inherent in this if one is incapacitated).

I'm not entirely convinced that this is a "winning" strategy, for a number of reasons:

1 - From a strictly practical viewpoint, how likely is it that you'll find an oncologist who's taking new patients?

2 - I'm concerned about the "offers different health plan options" verbiage: it seems to imply that one is already insured, but that one's current carrier doesn't have a presence in the state to which one is moving (or has moved). On the other hand, it is in the "Special" open enrollment category, which defines circumstances under which someone who is not currently insured may buy coverage.

To quote Jamie and Adam, I'll call this one "Plausible."

[Hat Tip: Ace of Spades]
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