Sign up to save your podcasts
Or
Share Ghost Enrollees in the ACA Marketplace Explained
Share to email
Share to Facebook
Share to X
Share to email
Share to Facebook
Share to X
Or
Ghost Enrollees in the ACA Marketplace Explained
Ghost enrollees in the ACA marketplace can distort enrollment reporting, affect risk adjustment transfers and increase CMS scrutiny. Even small pockets of unsupported enrollment can ripple through operations and financial reconciliation.
In this episode of Regulatory Joe, Joe Boyle breaks down what ghost enrollees actually are — and what they are not. Low utilization alone isn’t the issue. The risk shows up when enrollment patterns, premium payment behavior, repeated plan switching or grace period activity don’t align with normal member behavior.
EPISODE GUIDE:
00:00 Defining Ghost Enrollees and What’s Normal
02:00 Point of Sale and Broker-Driven Root Causes
05:00 How CMS Identifies Ghost Enrollee Patterns
10:00 How Health Plans Can ID Ghost Enrollee Patterns
12:00 Root Cause Review: Welcome Packets, Grace Periods, Reinstatement
16:00 Best Practices for Health Plans
Subscribe for ongoing ACA compliance guidance built for health plans.
Explore ClearFile: clearfilesolutions.com
Dive into all of Regulatory Joe’s insights: regulatoryjoe.com
View all episodes
By ClearFileGhost enrollees in the ACA marketplace can distort enrollment reporting, affect risk adjustment transfers and increase CMS scrutiny. Even small pockets of unsupported enrollment can ripple through operations and financial reconciliation.
In this episode of Regulatory Joe, Joe Boyle breaks down what ghost enrollees actually are — and what they are not. Low utilization alone isn’t the issue. The risk shows up when enrollment patterns, premium payment behavior, repeated plan switching or grace period activity don’t align with normal member behavior.
EPISODE GUIDE:
00:00 Defining Ghost Enrollees and What’s Normal
02:00 Point of Sale and Broker-Driven Root Causes
05:00 How CMS Identifies Ghost Enrollee Patterns
10:00 How Health Plans Can ID Ghost Enrollee Patterns
12:00 Root Cause Review: Welcome Packets, Grace Periods, Reinstatement
16:00 Best Practices for Health Plans
Subscribe for ongoing ACA compliance guidance built for health plans.
Explore ClearFile: clearfilesolutions.com
Dive into all of Regulatory Joe’s insights: regulatoryjoe.com