February 15, 2021

Affordable Care Act: Special Enrollment Period

By Steve Lavenda, Partner, Advisory Services

Affordable Care Act: Special Enrollment Period Healthcare

On January 28, President Biden signed a group of healthcare-related Executive Orders, one of which will reopen HealthCare.gov for a special enrollment period (SEP). This SEP began on February 15 and will be continue through May 15. (The previous open enrollment period ended on December 15, 2020.)

Americans currently without health insurance, and those needing to update an existing application in one of the 36 participating states, will have a chance to review their state’s health insurance marketplace options offered through the Affordable Care Act, also known as Obamacare. The remaining states that operate their own marketplace platforms are being encouraged to open a similar special enrollment period for their residents. This can provide many more Americans, particularly those who have dealt with unemployment and other life-changing events amid the COVID-19 pandemic, another chance to obtain insurance.

Although losing job-based health insurance qualifies you for a special enrollment period (even if you resign or are terminated), it’s only available for about 60 days, and many individuals and families don’t sign up within the required timeframe. It is estimated that 7.7 million workers lost their employer-sponsored health insurance due to the pandemic as of June 2020, according to the Commonwealth Fund report of October 7, 2020. When dependents are included, about 14.6 million people were affected. According to a November 24 paper published by the Kaiser Family Foundation, four out of 10 Americans not enrolled in insurance are eligible for free insurance under the Affordable Care Act.

The latest special enrollment period also provides the opportunity for those on a Consolidated Omnibus Budget Reconciliation Act (COBRA) health insurance plan to find a more cost effective option. While employers cover about 82% of health plan costs for individuals and 71% for families, those on COBRA incur the total cost themselves, plus a 2% administrative fee.

It should be noted that consumers enrolling in a plan on HealthCare.gov are guaranteed to receive comprehensive coverage, with no pre-existing condition exclusions or markups. All plans cover essential health benefits.

Some consumers may already be eligible for other existing SEPs, Medicaid, or the Children’s Health Insurance Program (CHIP). If so, they can visit HealthCare.gov to find out if they can enroll Starting February 15, consumers seeking to take advantage of this SEP can determine if they are eligible by visiting HealthCare.gov, and are no longer limited to calling the marketplace call center.

For more information, please do not hesitate to contact a Marcum advisor.