The executive order directs the Secretary of HHS to consider establishing a special enrollment period through HealthCare.gov that will run from February 15 to May 15, 2021. It cites provisions of the ACA governing the marketplaces and federal regulations that allow a special enrollment for “exceptional circumstances”—here, these circumstances are the ongoing COVID-19 pandemic.
The Health and Human Services Announcement
HHS immediately announced the HealthCare.gov special enrollment period in a press release and fact sheet. The special enrollment period will be available to all qualifying consumers who submit a new application or want to update an existing application (i.e., for current enrollees). State-based marketplaces can, but do not have to, allow for a similar special enrollment period, although some states have already announced that they will do so. Coverage is prospective, meaning it will begin on the first day of the month after a consumer enrolls through HealthCare.gov. Current enrollees will need to revise their current application to claim the special enrollment period and receive an updated eligibility determination. HHS’s fact sheet makes clear that applicants should face no heightened application questions or verification requirements (such as documentation to show they qualify for a special enrollment period).
$50 Million Committed To Outreach and Education
At the same time, HHS announced that it would commit $50 million to outreach and education to raise awareness of the special enrollment period. This is incredibly important since awareness of the marketplaces remains low, and the HealthCare.gov advertising and marketing budget was cut by 90 percent under the Trump administration. HHS can easily pull these funds from the user fees that insurers pay for the use of HealthCare.gov. A recent analysis from the Kaiser Family Foundation found that HHS currently has more than $1 billion in unused federal user fee revenue. These funds could be tapped to invest in HealthCare.gov marketing and advertising and the navigator program, as well as make other consumer-friendly improvements to HealthCare.gov and the call center. (Under the partial final payment rule for 2022, HHS would further cut the user fee for HealthCare.gov.)
How States Reacted
All but one state-based marketplaces provided broad COVID-19 special enrollment periods—leading, in some states, to record-high enrollment—and many invested in additional outreach and marketing. But the Trump administration refused to do the same for HealthCare.gov, despite widespread support from stakeholders such as insurer associations, gig economy companies (such as Postmates and Instacart), members of Congress, governors and attorneys general, and a broad coalition of more than 200 organizations. The refusal to allow a special enrollment period led to a lawsuit, although the new executive order and HHS action in response may lead to settlement or dismissal of that lawsuit.
How This Could Help You
A special enrollment period, paired with an aggressive advertising and marketing campaign, could have a significant impact. An analysis by the Kaiser Family Foundation suggests that nearly 9 million currently uninsured people could enroll in free or subsidized coverage through HealthCare.gov. Of these, 4 million would qualify for a no-premium bronze plan. An additional 6 million uninsured people could qualify to purchase unsubsidized ACA coverage if they can afford it. The executive order notes that people of color—Black, Latino, and Native American people, in particular—are more likely to be uninsured even while being disproportionately affected by the COVID-19 pandemic.
This broad special enrollment period is likely to be good for the marketplace risk pools rather than lead to adverse selection. State-based marketplaces have indicated that their COVID-19 special enrollment periods helped bring in younger enrollees. And the same Kaiser Family Foundation analysis notes that the remaining uninsured who could qualify for free or low-premium coverage are more likely to be young adults. For instance, 39 percent of the 4 million uninsured people who qualify for a no-premium bronze plans are between the ages of 19 and 34.