In ‘Do-Over,’ Enrollment in Affordable Care Act Health Insurance Reopens
People who missed open enrollment for Affordable Care Act health insurance late last year will get another opportunity to sign up, starting in mid-February.
President Biden signed an executive order last month creating an extra, three-month enrollment period starting Feb. 15. Consumers can again shop for coverage on HealthCare.gov, the federal insurance marketplace, which serves three dozen states.
“It’s a chance for a do-over of open enrollment,” said Cynthia Cox, director of the Kaiser Family Foundation’s Program on the A.C.A.
Because of the pandemic, millions of people lost their jobs, and the insurance that went along with those jobs, at a time of heightened health risk. Many of them may have found health coverage through Medicaid, the joint federal-state health insurance program for low-income people. But many people remain uninsured.
Typically, people may sign up for coverage outside open enrollment only if they can document “special” circumstances, like the birth of a child, a marriage or divorce, or the loss of health insurance. (They can generally enroll in A.C.A. plans within 60 days of losing health coverage. If they’ve lost their job recently, they can apply for coverage now.)
Open enrollment on HealthCare.gov ended on Dec. 15. (Dates for state marketplaces vary.) The extra sign-up window is expected to mimic open enrollment, said Cheryl Fish-Parcham, director of access initiatives at Families USA, a health insurance advocacy group. “You don’t have to prove” that you had a change in circumstances.
People who previously had job-based insurance but lost it during the pandemic may not realize that they are probably eligible for coverage with financial help, according to an analysis in January by the Urban Institute. Almost half of uninsured adults familiar with state and federal health insurance marketplace plans had not sought information on them, “most commonly because of cost concerns,” the report found.
“Many people who have lost employer insurance may not be familiar with the marketplace because they’ve never had to use it,” said Laura Packard, executive director of Get America Covered, a group that promotes increased health coverage.
About 15 million uninsured people are eligible to buy coverage through the marketplace, and about nine million of them qualify, based on their income, for free or reduced-cost monthly premiums, according to a Kaiser analysis.
This time around, the federal government is expected to spend $50 million on marketing and outreach efforts, to let people know that low-cost coverage is available, according to the Centers for Medicare and Medicaid Services, which administers HealthCare.gov. The Trump administration had cut advertising for the marketplace by 90 percent.
“Outreach efforts will include considerable awareness-building efforts” to encourage the uninsured to go to HealthCare.gov and enroll, according to a statement from the health care agency.
In addition to people who lack insurance, the open enrollment period is expected to apply to people who have A.C.A. coverage but want to switch plans, Ms. Cox said.
The Affordable Care Act, also known as Obamacare, provided for the sale of subsidized, private health insurance plans through federal and state marketplaces for people without job-based insurance. The 2010 law also expanded eligibility for Medicaid in many states. The law protects people with pre-existing conditions from being excluded from coverage, and requires health plans to provide certain essential coverage like preventive care.
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The Supreme Court is weighing a Republican-backed legal challenge to the Affordable Care Act. A ruling is expected by June. But in oral arguments in the case in November, a majority of the justices indicated that they would reject attempts to kill the law.
Here are questions and answers about the special open enrollment period:
Where can I get help choosing a health plan?
Visit HealthCare.gov and click on “find local help.” This will list approved brokers and “assisters” who are authorized to guide consumers in selecting coverage. (Or call 800-318-2596.) Starting with trained helpers will steer shoppers clear of “junk” plans that may not provide all the care required by Obamacare plans, Ms. Packard said.
“If a plan looks too good to be true, be skeptical,” she said.
She urged shoppers to consider costs beyond the monthly premium, especially if family members have chronic health conditions like diabetes. “Human nature is to pick the cheapest one,” she said. But lower monthly premiums typically mean higher out-of-pocket costs, which can add up if someone needs regular medication and treatments.
Consumers can preview plans and prices now at HealthCare.gov. Rates are set for the plan year, so they will be the same as they were during open enrollment, according to the Centers for Medicare and Medicaid Services. (If you’ve had a birthday since Jan. 1, however, you may see a rate increase because of your higher age.)
How long will the extra HealthCare.gov open enrollment period last?
The special enrollment period is twice as long as last year’s open enrollment, to give people more time to shop and buy coverage. The period will run from Feb. 15 through May 15, according to the Centers for Medicare and Medicaid Services.
Coverage chosen during the extra enrollment period will begin the first of the month after selection of the plan.
What if I live in a state that manages its own health insurance marketplace?
Fourteen states and the District of Columbia run their own exchanges. Most have said they will also reopen enrollment to mirror HealthCare.gov. Dates of the extra enrollment period may vary by state. To confirm the details, check with your state’s marketplace. If you start at HealthCare.gov, you’ll be directed to your state’s marketplace.
Ms. Fish-Parcham suggested that even if your state didn’t formally extend open enrollment, it was worth checking to see if you could qualify for a “special” enrollment category, especially if you had lost income during the pandemic.
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