More on SEPs (Spoiler: No #ACATaxTime this year!)

One more tidbit regarding the debate over how many people are "gaming the system" by abusing the Special Enrollment Periods allowing off-season exchange enrollment: Last spring, after the official Open Enrollment Period (along with the week-long "overtime" period tacked on for people "in line by midnight") ended, the HHS Dept., along with almost all of the state-based exchanges, decided to allow a 6-week "Tax Filing Season" special enrollment period. The idea was that this was the first year that people who hadn't gotten covered with ACA-compliant healthcare coverage the previous year would be hit with a tax penalty ($95 or 1% of their household income), and that as such, it was a bit unfair to dump that on those who truly "had no idea" that there was any sort of financial penalty for not doing so.

Of course, after years of nearly non-stop argument and debate over the "Individual Mandate Penalty" (actually the "Individual Shared Responsibility Provision"), which had been one of the most contentious parts of the ACA all along, you'd think that anyone who didn't know about it was in a coma, but whatever; some people claimed as such. The #ACATaxTime SEP didn't get people out of paying the 2014 penalty, it simply gave them an extra chance to avoid (most) of the 2015 penalty (which itself had jumped up to $325 per person, or 2% of their household income).

The starting and ending dates varied for some of the state exchanges, and three of them (Colorado, Idaho and Massachusetts) didn't allow for one at all, but for HC.gov and most state exchanges it ran from around March 15th through April 30th...roughly 6 weeks.

Speculation abounded as to how many people might sign up during this SEP; my own wild guess was that it might be as high as 600K - 1.2 million, but I really hadn't a clue.

In the end, however, only about 214,000 people did so nationally (147K via HC.gov plus another 67K or so via the various state exchanges). Apparently anyone who still honestly didn't know about the penalty after all that time also isn't likely to notice when they're given an extra shot at avoiding it the following year (or they deliberately choose to defy the law, a distinct possibility these days).

Anyway, the other day, CMS decided to roll out "The Stick" a week earlier than I had figured (ie, pushing the penalty for not being covered instead of the benefits of being covered) with a list of 5 bullet points about the Mandate penalty. The first four points should be old news, but number 5 has an important clarification:

• The fee is calculated one of two different ways, depending on your situation. The fee for not having health insurance if you can afford it is calculated either as a percentage of your annual household income or a set amount for each person in your household who does not have coverage. When you file your federal income taxes, if you are uninsured for more than three months despite having access to affordable coverage, you’ll be required to pay whichever amount is higher. Resources on HealthCare.gov will help you estimate the fee you’ll have to pay if you don’t have health insurance based on your own situation.

• The fee is increasing for 2016. For 2015, the fee for not having health insurance if affordable insurance is available to you and you don’t qualify for an exemption is $325 per person or 2 percent of your annual household income – whichever is higher. For 2016, the fee you’ll have to pay if you choose to go without health insurance will increase to $695 or 2.5 percent of your income – whichever is higher. For many people, that’s more than the yearly cost of affordable plans they can find on the Marketplace. Generally, the higher your income, the higher the fee you will have to pay.

• Every month without coverage counts. The fee is calculated based on the number of months you, your spouse, or your tax dependents went without qualifying coverage, such as an employer-sponsored health plan, Medicare, Medicaid or coverage through HealthCare.gov. The more months you go without health coverage, the higher the fee you will have to pay, up to the maximum.

• For some people, exemptions from the fee are available. People with very low incomes and individuals who meet other specific conditions can receive an exemption from the requirement to have health insurance and will not have to pay the fee. Additional information about exemptions and a tool that helps you determine if you qualify for an exemption is available on HealthCare.gov.

• If you need health coverage and want to avoid the fee for 2016, enroll in a plan by January 31. It’s important to remember that the final deadline to sign up for 2016 coverage through HealthCare.gov is January 31. A Special Enrollment Period around the April 15 tax filing deadline will not be offered this year. If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes.

Got that? It's possible that a few of the state exchanges will go ahead and allow an #ACATaxTime SEP again this year, but I wouldn't count on it; 3 of them didn't do so last year and HC.gov isn't doing so this year. Plus, HC.gov covers one more state this year (Hawaii joined Oregon, Nevada and New Mexico in moving to the Mother Ship for 2016, remember?). That leaves just 10 states to potentially do so.

What about the "#ACAOvertime" period, designed specifically for people who started the enrollment process before the official deadline, but didn't complete it yet? Well, in 2014 this made total sense; the technical messes at HC.gov and many state exchanges were still being sorted out, so people were given an extra 15 days (April 1st - April 15th), which yielded about 900,000 additional QHP selections (the total went from 7.1 million to 8.0 million).

In 2015, most of the technical bugaboos had been worked out, but some remained. The "overtime" period was sliced in half to just 7 days, and yielded just an additional 300,000 or so (raising the official #OE2 total from 11.4 million to 11.7 million).

What about 2016? Well, I could see going either way on this. They might tack on another week, they might not. Perhaps they'll only allow 3 extra days or whatever. Perhaps HC.gov won't, but some state-based exchanges will, or vice versa.

My guess is that they likely won't announce an "official" Overtime period, but will quietly accept those who were "waiting in line by midnight" on a case-by-case basis, without making a big fuss about it, which seems about right to me. Of course, this assumes they don't have any significant last-minute major technical snafus this time around.