Updated: Important details about the HC.gov #COVID19 SEP...

As I noted earlier today, the Big News® this today is President Biden's pending Executive Order to re-open HealthCare.Gov to a full 3-month COVID-19 Special Enrollment Period starting on February 15th. There's a whole bunch of other important stuff in today's healthcare XO, but some of them will take months to actually finalize and implement.

Frankly, re-opening HC.gov is actually one of the simplest and most obvious healthcare-related executive orders Biden could give at the moment. Now that the starting/ending dates are known, it raises one other important question.

During the official Open Enrollment Period, pretty much anyone can sign up as long as they're a documented resident of the U.S. During a traditional Special Enrollment Period (SEP), you have to have had a Qualifying Life Experience (QLE) within the past 60 days, such as losing your existing healthcare coverage, turning 26, getting married/divorced, moving outside your rating area and so on...and you also have to provide documentation verifying your QLE (a termination of coverage notice, marriage certificate, etc).

The question about the new HC.gov COVID SEP is whether it will be fully open to anyone eligible to enroll via the exchange (that is, "no excuse needed" as in the official Open Enrollment Period) or whether it will be limited to those not currently enrolled in ACA-compliant healthcare coverage.

This is how Nevada Health Link and one or two other state-based exchanges handled their COVID SEPs this way last spring: They required enrollees to attest that they did't enroll during Open Enrollment and/or that they are currently uninsured. The reason for this is to avoid "plan hopping" where people who are already covered by one healthcare policy switch to a different one mid-year to game the system; the point of this SEP is for people without ACA-compliant coverage at all.

I don't know whether the HC.gov SEP will be completely open as it was last fall or whether it'll be limited to the currently uninsured, but even if it is, that doesn't necessarily have to be a big deal. HC.gov could simply add a checkbox to the application form stating "I hereby attest that I am not currently enrolled in PPACA-compliant healthcare coverage" or something along those lines; after that the rest of the enrollment process would be exactly as it is during OEP.

UPDATE: Well, there you go: My question has already been answered by CMS via this press release:

Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan. In order to use this SEP, current enrollees will need to step through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment. This SEP opportunity will not involve any new application questions, or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage. In addition, consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.

This certainly sounds to me like it'll be effectively exactly the same as the formal Open Enrollment Period after all.

Note: The wording ("same level of coverage") made me think that current enrollees might be restricted to the same metal level (Gold > Gold, Silver > Silver), but I've confirmed via several sources that this isn't the case.

Another interesting and welcome piece of news from the CMS press release:

To promote the SEP and ensure that a broad and diverse range of consumers are aware of this implementation, CMS will conduct an outreach campaign in cooperation with community and stakeholder organizations, focused on education and awareness of this new opportunity to enroll in English, Spanish and other languages.  CMS outreach efforts will use a mix of paid advertising and direct outreach to consumers. Outreach efforts will include considerable awareness building efforts to encourage the uninsured and those who come to HealthCare.gov to explore coverage to continue the process and enroll. CMS plans to spend $50 million on outreach and education, on a mix of tactics to increase awareness, including advertisements on broadcast, digital, and an earned media.

This is exactly what I was talking about a week ago. Trump's CMS Administrator Seema Verma basically starved the HC.gov budget by slashing both marketing/outreach and the navigator/assister budgets to the bone. The Biden Administration is restoring funding...not back to the full $100 million or so from the Obama years, but this is still a huge improvement (in addition, this is for the secondary Open Enrollment Period, not the primary one, and isn't expected to enroll as many people no matter what).

The only other thing which surprised me at first was the announcement that the COVID19 SEP will be for 90 days; I figured it'd be either 30 or 60 at the outside. Some of the state-based exchanges went well beyond 60 days last year (it became a bit of a running joke, in fact, with states bumping it out by a month each month for awhile...eventually both Maryland and the District of Columbia basically just said "to hell with it" and effectively made Open Enrollment last the entire year). WIth the federal exchange, however, I figured they'd stick to a 30 or 60 day window.

Instead, they're going with 90 days: February 15th - May 15th. While this surprised me, the more I thought about it, the more sense it makes, for two key reasons:

  • First, because it means the SEP will overlap with tax filing season. HC.gov offered a 45-day "Tax Time" SEP back in spring 2015, the first year that the ACA's federal individual mandate penalty was enforced, though it was limited to people who attested that they "didn't know" there was a penalty (which I found hard to believe, but whatever). The federal penalty may be gone now, but having it overlap with the tax filing season should still bump up enrollment. Of course, that only gets you to April 15th, but some people file late.
  • The second reason is more subtle: The #TexasFoldEm lawsuit. Remember, the Supreme Court heard oral arguments in the case back in November (a week after the election), but they aren't expected to release their ruling on the case until sometime this spring or early summer...most likely sometime in April - June. Having ACA enrollment still ongoing through mid-May means that the ACA will likely be back in the news and in the public's mind right around the same time the SCOTUS issues their decision.

None of this will impact their ruling, of course, but it still helps to remind the public of everything which is at stake with this case.