Reports highlight eligibility problems with health insurance exchanges

health insurance exchange problems

Insurance exchanges come under fire due to eligibility concerns

health insurance exchange problemsThe U.S. Department of Health and Human Services’ Office of Inspector General has released reports concerning the health insurance coverage people have obtained through state and federal exchanges. The Affordable Care Act, which established these insurance exchanges, has come under fire recently due to concerns that people are taking advantage of federal subsidies even though they are not eligible to receive this financial support. The reports suggest that many people that have received coverage through state and federal exchanges were not actually eligible for coverage at all.

Report suggests that many people receiving coverage through exchanges are not eligible for this coverage

One of the reports released by the Office of Inspector General focuses on the issue of federal subsidies. The report suggests that many people that have applied for and are now receiving these subsidies are not actually eligible for them. The other report highlights the eligibility of people seeking coverage through state and federal insurance exchanges. These exchanges are designed to be a marketplace where people can find affordable coverage, but they must apply for this coverage and cannot simply buy policies outright.

As many as 3 million people may be receiving coverage that they are not eligible for

The report suggests that as many as 3 million people have submitted information during the application process that is inconsistent with federal records. In many cases, applicants supplied inaccurate financial information in order to receive access to certain types of health insurance plans, such as those offered through Medicaid. In other cases, people provided inaccurate citizenship information. Notably, many of the problems that insurance exchanges are facing in regards to determining eligibility have to do with their internal controls.

Internal controls could be the problem with insurance exchanges

A recent report from the Department of Health and Human Services highlighted the bureaucratic nightmare that these internal controls represent. The report claimed that internal controls were not effective enough to adequately regulate exchanges. How these controls will be changed in the future is not yet clear, but many states have already begun revising their exchanges in order to prepare for a new open enrollment period later this year.

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