Government Eliminates Several ACA Special Enrollment Periods

After pressure from insurers over concerns of rising costs, the government is eliminating several special open enrollment periods and will provide stronger enforcement of the remaining special open enrollment periods.

After insurers raised concerns with the government that the more than 30 “special enrollment” categories allowing individuals to sign up for health coverage after the deadline would drive up costs, the Obama administration announced it was making some changes.

In a blog post, Kevin Counihan, health insurance marketplace CEO, wrote that the government will be making changes to the marketplace and acknowledged that it has to be not only attractive for consumers, but also the insurance companies offering plans. Recently, UnitedHealth has announced that its losses on the Affordable Care Act’s marketplace have been larger than expected, and it will likely not participate in 2017.

“As the Marketplace grows and evolves, we continue to analyze data to understand how our rules are impacting insurers and consumers and to make sure they are working to sustain a stable Marketplace,” Counihan wrote. “By having clear rules for how the Marketplace operates and making adjustments when needed, we are creating a more stable rate environment with more affordable plan choices for consumers.”

He explained that the special enrollment periods have been particularly scrutinized. While a large number of these periods were created for consumers to enroll outside of the normal open enrollment period as people were still learning how to enroll in coverage for the first time. Now, the government is eliminating some of the unnecessary special enrollment periods. In addition, Counihan explained that the government will provide strong enforcement of these periods to ensure consumers aren’t taking advantage of the periods to enroll when they get sick before dropping coverage again.

The government had previously announced it was no longer offering the tax season special enrollment period, and now another 6 are being eliminated. The government will no longer offer special enrollment for:

  • Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
  • Consumers who were affected by an error in the treatment of Social Security Income for tax dependents
  • Lawfully present non-citizens that were affected by a system error in determination of their advance payments of the premium tax credit
  • Lawfully present non-citizens with incomes below 100% FPL who experienced certain processing delays
  • Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
  • Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program

“While there will continue to be special enrollment periods for people who lose coverage mid-year or experience other life changes, this channel for enrollment will not be available for the vast majority of consumers,” Counihan wrote.