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Will Individual Health Special Enrollment Period Really End Aug. 15?

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What You Need to Know

  • The individual major medical open enrollment period was running from Nov. 1 through Dec. 15.
  • Officials added a long special enrollment period this year because of the COVID-19 pandemic.
  • Connecticut already has extended its SEP to Oct. 31.

The Affordable Care Act health insurance exchange in Connecticut is raising the question: Will the current Aug. 15 end date for the COVID-19 pandemic special enrollment period stick?

Managers of HealthCare.gov — a program that provides ACA enrollment and premium subsidy administration for people in much of the country — are emphasizing that consumers should sign up for coverage by Sunday, or face the possibility that they could end up getting sick or injured at a time of the year when they can’t buy health insurance

White House officials often have talked about the Aug. 15 deadline during press conferences and other events. In fact, President Joe Biden promoted the special enrollment period Thursday, during remarks at the White House.

Biden noted that ACA exchange program users’ average monthly cash outlay for health insurance has dropped to $62, from $104. That decrease is the result of temporary subsidy rule changes included in the Americans Rescue Plan Act, a COVID-19 response law.

“Earlier this week, I announced that more than 2.5 million Americans have signed up for coverage under the Affordable Care Act since I called for the special enrollment period during this pandemic,” Biden said. “Folks, if you don’t have insurance, you can still sign up under the Affordable Care Act through Sunday, August the 15th. Just go to HealthCare.gov today, and get covered.”

But Connecticut’s exchange, Access Health CT, may have reduced some of the pressure to sign up for coverage quickly by announcing last week that it was extending its enrollment deadline to Oct. 31.

Health Insurance Enrollment Period Basics

The Affordable Care Act — a two-law package that came to life in 2010 — eliminated many of the defenses health insurers once had against spikes in claim costs, such as refusing to provide health coverage for people who were already very sick.

In exchange, Congress tried to protect insurers against huge losses by creating the ACA exchange program, or web-based supermarkets for health insurance, and exchange plan premium tax credit subsidies to encourage healthy people to sign up for and pay for health coverage.

State insurance regulators, ACA exchange programs and insurers also came up with another defense: use of open enrollment periods, or limits on when people can sign up for health coverage without showing they have what the government classifies as a good excuse to be shopping for health coverage.

The idea is to push healthy people to pay premiums when they feel fine by raising the possibility that they could end up facing huge medical bills if they fail to get covered and then become sick or injured outside the open enrollment period.

In recent years, the individual and family major medical insurance open enrollment period was running from Nov. 1 through Dec. 15 in most of the country.

Long-Term Impact

The Congressional Budget Office predicted in February that the kinds of changes included in the American Rescue Plan Act bill might help only about 1.5 million of the 15 million eligible uninsured people get covered.

Peter Lee, the executive director of Covered California, said in March that successful efforts to get significantly more uninsured people covered with help from the temporary American Rescue Plan Act subsidy could increase the odds that Congress would move to make the temporary subsidy increases permanent.

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(Image: Centers for Medicare and Medicaid Services)