Health insurers, public and private exchange programs, and traditional agents and brokers today started the first Affordable Care Act (ACA) individual major medical open enrollment period that will begin under the administration of President Donald Trump.
The open enrollment period — the time when people can buy coverage for 2018 without showing they have what regulators believe to be a good excuse for shopping for coverage — started today throughout the country.
A New Schedule
For 2017 coverage, the open enrollment period lasted from Nov. 1, 2016, to Jan. 31, 2017.
For 2018 coverage, in states that use the HealthCare.gov ACA exchange enrollment and administration system, the Trump administration has scheduled the open enrollment period to end Dec. 15.
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That schedule means that much of the HealthCare.gov 2018 individual major medical open enrollment period will overlap with the Medicare plan annual election period, which runs from Oct. 15 to Dec. 7.
Many states that run their own state-based exchange programs say they will give their residents until Jan. 31, 2018, to sign up for 2018 coverage.
A Shield Against ‘Free Riders’
The ACA drafters in Congress eliminated many of the traditional defenses, such as medical underwriting and benefits limits, that health insurers once used to protect themselves against claim risk. Most of those changes applied to new major medical coverage that took effect on or after January 2014.
Insurers feared that the new ACA rules would encourage many younger, healthier consumers to act as “free riders,” and to pay for coverage only when they thought they would need expensive health care.
To reduce the risk that consumers would see the new underwriting rules as an invitation to pay for coverage only when they arrived at the hospital door, regulators, ACA exchange programs and insurers developed the open enrollment system.
The open enrollment systems lets eligible people buy coverage on a guaranteed-issue basis during an annual open enrollment period.
At other times of the year, people who want major medical coverage can show they qualify for a “special enrollment period” (SEP) because they have moved, lost employer-sponsored health coverage, had a child, or met some other conditions on the government’s list of conditions that make health insurance shoppers eligible for SEPs.
The 2018 open enrollment period is the fifth conducted under the ACA open enrollment period rules.
No Open Enrollment Calendar
The ACA drafters excluded some types of coverage from the effects of most or all ACA major medical coverage rules.
Because of those exclusion provisions, the ACA underwriting rules, and the ACA open enrollment period system, do not apply to short-term health insurance or to a variety of “gap-filler” products, such as hospital indemnity insurance, critical illness insurance or accident insurance.