Health insurers are complaining that many enrollees inPPACA federal and state marketplaceexchanges are waiting until they need expensive medical care tosign up for insurance by taking advantage of “special enrollmentperiods” that fall outside of the open enrollment seasons.

The Obama administration appears to be listening.

Andy Slavitt, the acting administrator for the Centers forMedicare and Medicaid Services, said in a speech Monday that theadministration has to review rules for special enrollment periods,which he conceded were subject to abuse, reports Politico.

"There may be bad actors and others out there who are abusingthose,” he said.

The feds will be taking the complaints seriously in the midst ofthreats from some major insurers, such as UnitedHealth, to stop participating inthe Patient Protection and Affordable CareAct marketplace because they aren’t making money.

As of June of last year, only 10 percent of all marketplaceenrollees had signed up during a special enrollment period.However, the Blue Cross Blue Shield Association estimates thatthose enrollees cost an average of 55 percent more.

In a letter to Secretary of Health and Human Services SylviaBurwell, an Aetna executive claimed that a quarter of its enrolleescame through special enrollment periods, and that such enrolleesstay on their plans for an average of less than four months.

“Many individuals have no incentive to enroll in coverage duringopen enrollment, but can wait until they are sick or need servicesbefore enrolling and drop coverage immediately after receivingservices, making the annual open enrollment period meaningless,”wrote Steven B. Kelmar, executive vice president of Aetna.

The problem is, there appears to be little means for insurers toverify that an applicant qualifies for special enrollment, which isavailable for a variety of events, including losing insurance dueto a job change or job loss.

“State regulators are concerned that consumers are not requiredto provide documentation to substantiate their eligibility for aspecial enrollment period,” wrote the National Association ofInsurance Commissioners in a letter to the HHS. “We know of manycases where individuals with serious medical conditions purchasedcoverage midyear by simply checking the right box or using theright language, and their eligibility was not questioned.”

The New York Times reports that even nonprofitinsurers and advocacy groups, such as Kaiser Permanente, that havebeen big supporters of the PPACA are urging the feds to createstricter rules to prevent special enrollees from bleeding thesystem dry.

The problem is that any effort to crack down on inappropriateenrollment will likely mean that it will become more difficult forthose who are playing by the rules to join. Unfair rejections have already been amajor issue that has prevented many from signing up for insuranceand has resulted in many others being kicked off of theirplans.

Christine Speidel, an attorney for Vermont Legal Aid, told theTimes that consumers are unlikely swindling insurers.

“Most consumers are confused by the rules on special enrollmentperiods and do not understand the system well enough to try to gameit,” she said.