Clarifying Special Enrollment Periods

by Kevin Counihan
Health Insurance Marketplace CEO

As the Health Insurance Marketplace grows and matures, we continue to listen and learn to find ways to make it work even better for consumers and those who serve consumers. In addition to continually improving the consumer experience, we also must make changes to keep the Marketplace vibrant, stable and strong.

The fundamental principles to achieve this are simple: the Marketplace must be attractive for consumers, and the Marketplace must be attractive for insurance companies that offer plans on it.

Consumers need to know that affordable options are available and that insurers are competing for their business. We know that consumers want affordable health care and value the insurance they’re finding at the Health Insurance Marketplaces. This Open Enrollment we’ve seen a significant influx of new consumers – many of them young – making it clear there is still a large untapped market for insurance companies to serve.

The Marketplace must also be attractive to insurers, so that they make quality plans available at affordable prices and continue to drive innovation, and so consumers can find plans that meet their health and budget needs. Building an attractive Marketplace starts with establishing a predictable, stable set of rules that help to keep the risk pool balanced.

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.

One of the areas we have been reviewing closely is the Special Enrollment Periods (SEPs) we offer. SEPs are an important way to make sure that people who lose their health insurance during the year or who experience a major life change like getting married, or having a child, have the opportunity to enroll in coverage through the Marketplaces.

People who experience these qualifying events have the opportunity to enroll in coverage outside of the normal Open Enrollment period from November 1 to January 31, similar to how enrollment works in the employer market.

The action we are taking announces the elimination of several unnecessary SEPs, clarifies the definitions of other SEPs, and provides stronger enforcement so that SEPs serve the purpose for which they are intended and do not provide unintended loopholes.

1. Eliminating unnecessary SEPs: Last month, we announced that the Tax Season special enrollment period would no longer be offered. Today we are announcing the elimination of six other SEPs that are no longer needed. Just as the Marketplace evolves, so too does consumer behavior. The rules we use to operate the Marketplace need to keep up with these changes. As such, SEPs are no longer available 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

We’ll continue to monitor how SEPs are used and may make changes in the future as Marketplace systems and operations continue to improve.

2. Clarifying eligibility: Our review of current SEPs also showed that some of the eligibility guidelines need to be further clarified so consumers can understand the intent and so they will not be abused. Now we are updating guidance to more clearly define the special enrollment period that is available to consumers who permanently moved, and as a result, gained access to new health plans, by clarifying that this SEP cannot be used for a short-term or temporary move.

3. Enforcing the rules: Finally, we will take steps to make sure that consumers understand and comply with the rules.

We will also emphasize more strongly to applicants that the law requires that consumers provide accurate information to the Marketplace, and that there are penalties if they intentionally provide false or untrue information.

The Gayly- 3/30/2016 @ 9:29 AM CST