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HHS exchanges to loosen PPACA enrollment deadline

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The U.S. Department of Health and Human Services (HHS) will be giving consumers more time to complete commercial coverage applications in the states where it runs the public exchange programs.

News was leaked to the Washington Post Tuesday, and HHS officials confirmed the leaks for New York Times reporters.

HHS and the Centers for Medicare & Medicaid Services (CMS), the HHS agency that manages the HHS-run exchanges, are not officially changing the March 31 individual “qualified health plan” (QHP) enrollment period for everyone, but they will make a special enrollment period available to consumers who start the individual QHP application process by March 31 and fail to complete the process by that date.

Up until mid-April, a consumer can ask for the application time extension by checking a box on the HHS exchange enrollment website.

HHS will not be able to verify whether the consumers have really started the application process and will depend on consumers to say whether they have or not, according to the press reports.

Consumers who apply for extensions after mid-April will have to call a call center and provide evidence showing that they qualify for a special enrollment period.

HHS will make a formal announcement about the extension today, according to the press reports.

Independent confirmation from HHS was not immediately available, but HHS said in a request for a comment on the Washington Post story that “open enrollment ends March 31.”

We are experiencing a surge in demand and are making sure that we will be ready to help consumers who may be in line by the deadline to complete enrollment—either online or over the phone,” HHS said in a statement.

The Patient Protection and Affordable Care Act (PPACA) now requires sellers of individual and small-group major medical coverage to sell the coverage on a guaranteed-issue basis. The only personal health information they can use when setting rates is age.

To discourage consumers from waiting until they become seriously ill to pay for coverage, HHS and state regulators developed a limited “open enrollment period,” or period when consumers can automatically qualify to apply for coverage, for individual QHP coverage.

The individual QHP open enrollment period started Oct. 1. The cut-off does not apply to small-group coverage, Medicaid coverage or Children’s Health Insurance Program (CHIP) coverage.

After the end of the ordinary open enrollment period, consumers will still be able to apply for individual QHP coverage if they can show that they have gone through a major life event, such as a marriage or the loss of a job, and they also can justify a request for a “special enrollment period” by showing that they should qualify for a hardship exemption for some other reason.

In most states, under current rules, consumers who do not qualify for a special enrollment period will not be able to start new applications for coverage from April 1 through Nov. 15, when the QHP open enrollment period for 2015 coverage is set to begin.

Managers of Nevada’s state-based exchange recently reported that PPACA and HHS regulations give them the authority to extend QHP open enrollment for up to 60 days. The Nevada Health Link exchange hopes to offer a full 60-day extension to anyone who started the application process before March 31 and was unable to complete the process.

Managers of the state-based Maryland Health Connection exchange will be offering a similar extension to consumers who call a telephone hotline by March 31 and say they had trouble completing the individual QHP application process.

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