Today, President Biden signed two highly anticipated executive orders related to healthcare. The first is aimed at strengthening Medicaid and the Affordable Care Act, and will include a provision to create a COVID-related special enrollment period (SEP) on HealthCare.gov, for Americans who don’t currently have health coverage. State officials, insurers, and consumer advocates repeatedly asked the Trump administration for a COVID-related special enrollment period in 2020, but to no avail. (Almost all of the state-run exchanges did open COVID-related SEPs in 2020.)
When will the HealthCare.gov special enrollment period start?
The special enrollment period will run from February 15 to May 15, giving uninsured Americans three months in which to pick a health plan, even if they don’t otherwise have a qualifying event.
Who can use the COVID special enrollment period on HealthCare.gov?
This window is expected to be aimed at Americans who are uninsured, much like the COVID-related special enrollment periods that had already been announced in Maryland, Massachusetts, and New York. But the COVID-related SEP in Massachusetts also applies to people who have COBRA and would prefer to drop it and switch to a plan offered through the marketplace – it’s possible that the SEP on HealthCare.gov could be extended to populations like that as well.
Americans are technically considered uninsured if they have coverage under short-term health plans, Farm Bureau non-insurance plans, fixed indemnity plans, healthcare sharing ministry plans, direct primary care plans, and other similar types of coverage, since none of those are considered minimum essential coverage. So people with these types of coverage will be able to use the COVID special enrollment period on HealthCare.gov. And again, it’s also possible that this window could be extended to other groups as well, including those who have COBRA or state continuation coverage after a recent job loss.
Will state-run marketplaces also offer a special enrollment period for uninsured residents?
HealthCare.gov is used in 36 states, and the COVID SEP will apply in all of them. But it’s also likely that many of the state-run exchanges – in addition to Massachusetts, Maryland, and New York – could follow suit. Colorado’s exchange announced today that they’ll open a special enrollment period for uninsured residents, which will run from February 8 through May 15, and Washington’s exchange announced a special enrollment period, with the same dates that HealthCare.gov will use, for “anyone seeking health insurance coverage.”
Last month, insurance commissioners from 11 states sent a letter to President Biden, encouraging him to take various actions to improve access to health coverage and care. Opening a special enrollment period was among their recommendations, along with “restoring outreach funding, restoring flexibility on eligibility rules like failure to reconcile, and immediately revoking public charge rules.”
The insurance commissioners who wrote the letter – six of whom represent states that run their own exchanges (California, Colorado, Minnesota, Pennsylvania, Rhode Island, and Washington) – further noted that
“many of our states run our own state-based marketplaces and we would like to work with you to ensure that any effort to encourage marketplace enrollment is truly national and therefore inclusive of state-based marketplaces, in addition to HealthCare.gov. We ask you, as soon as possible, to coordinate with state-based marketplaces on the timing of any SEP, the messaging you intend to use, and key strategies you will employ to reach the uninsured so that we can align our plans with yours.”
So it’s quite likely that many of the remaining state-based marketplaces will open COVID-related SEPs this spring, allowing uninsured residents another opportunity to sign up for health coverage.
How can I get coverage between now and February 15?
If you’re uninsured and not in one of the states where open enrollment for 2021 plans is ongoing until the end of January, your options for getting coverage before the new special enrollment period will be limited.
But you likely do still have at least some options, as outlined here. If you’re eligible for Medicaid or CHIP, enrollment continues year-round, with coverage that can take effect immediately or even retroactively. Otherwise, you may have to consider a plan that’s not regulated by the Affordable Care Act, such as a short-term plan or health care sharing ministry, to tide you over until you can enroll in a plan through the marketplace.
What else will the executive orders do?
The special enrollment period for uninsured Americans is generating headlines and will be available in just a couple of weeks. But the executive order is expected to direct federal agencies to consider a variety of other reforms, which could have far more significant impact.
Among the most likely are
- restoring funding for navigators and the outreach/education work that HealthCare.gov was able to do under the Obama administration,
- rolling back the Trump administration’s relaxed rules for short-term health plans (in order to protect people with pre-existing conditions),
- no longer approving Medicaid work requirements, rolling back the relaxed guardrails for 1332 waivers that the Trump administration championed,
- changing the way affordability of employer-sponsored plans is calculated (in order to fix the family glitch), and
- possible solutions that would eliminate the subsidy cliff and make coverage more affordable for people with income a little above 400 percent of the poverty level.
The second executive order will be aimed at protecting women’s health in America and around the world, including ensuring access to all necessary reproductive health care. It’s expected to rescind the global gag rule (Mexico City Policy), which blocks U.S. funding for international non-profits that provide women with abortion counseling or referrals. The rule was first implemented in the 80s and has been rescinded and reinstated several times under different administrations.
It’s also expected that the women’s health executive order will direct federal agencies to reconsider the Trump administration rule that eliminated federal funding for Planned Parenthood and other abortion providers.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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