Breaking: HHS Sec. Becerra extends 2021 #COVID19 SEP deadline out to August 15th

June 16, 2020:

On March 20th, the Vermont Health Connect ACA exchange joined other state-based exchanges in launching a formal COVID-19 Special Enrollment Period.

On April 15th, just ahead of the original SEP deadline, they bumped it out by a month.

Then, with the May deadline approaching, I took a look and sure enough, they've bumped it out another month.

And now, with the June deadline having come and gone...

Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period until August 14, 2020.

I admit that this is starting to get a bit silly. At a certain point I'm guessing at least one of the state exchanges will just say "screw it" and open 2020 enrollment up for the full year.

The point of a deadline is a) to prevent people from trying to game the system by deliberately waiting until they're sick/injured before enrolling in coverage (thus driving up premiums for everyone else) and b) to goad people into actually taking action (deadlines do have a clear positive impact on enrollment). With the COVID-19 pandemic having thrown the entire healthcare system into disarray, neither of those seem to be much of a factor this year.

August 7, 2020:

ANNAPOLIS, MD—Gov. Larry Hogan was joined today by Insurance Commissioner Kathleen Birrane, insurance companies, and the Maryland Health Benefit Exchange to announce the reopening of the coronavirus emergency special enrollment period until Dec. 15. More than 54,000 Marylanders enrolled in health coverage during the special enrollment period from March 16 to July 15. With today’s announcement, Maryland will offer the longest special enrollment period in the nation related to the coronavirus emergency.

September 11, 2020:

Put quite simply, the Maryland ACA exchange did exactly what I predicted--they basically realized that in a highly-contagious, deadly pandemic, the normal rules about risk pools and adverse selection don't make much sense, decided that the 2020 actuarial assumptions were all pretty much kaput anyway, and decided to open up enrollment through the end of the year.

Washington, DC­­ –The DC Health Benefit Exchange Authority (DCHBX) Executive Board unanimously voted to adopt the recommendations from its Standing Advisory Board to extend the Special Enrollment Periods (SEP) for COVID-19 for District residents who need health insurance and for employees and dependents of employers already covered on DC Health Link to January 31, 2021, or longer if the District’s public health emergency is extended later than that date.

Moments Ago:

NEWS: The special enrollment period for the federal health insurance marketplace is extended from May 15 to August 15, @SecBecerra announced today during a visit to Carson City.

— Jazmin Orozco Rodriguez (@jazmin1orozco) March 23, 2021

NEW: The Biden administration is extending the HealthCare.Gov special enrollment period by three months to August 15. This will give Americans more time to take advantage of benefits granted through Biden's Covid-19 economic relief law.

— Kate Sullivan (@KateSullivanDC) March 23, 2021

Sure enough, via CMS:

2021 Special Enrollment Period Access Extended to August 15 on HealthCare.gov for Marketplace Coverage

Today, President Biden announced that the Centers for Medicare & Medicaid Services (CMS) is extending access to the Special Enrollment Period (SEP) until August 15 – giving consumers additional time to take advantage of new savings through the American Rescue Plan. This action provides new and current enrollees an additional three months to enroll or re-evaluate their coverage needs with increased tax credits available to reduce premiums.

“Every American deserves access to quality, affordable health care – especially as we fight back against the COVID-19 pandemic,” said HHS Secretary Xavier Becerra. “Through this Special Enrollment Period, the Biden Administration is giving the American people the chance they need to find an affordable health care plan that works for them. The American Rescue Plan will bring costs down for millions of Americans, and I encourage consumers to visit HealthCare.gov and sign up for a plan before August 15.”

As a result of the American Rescue Plan, additional savings will be available for consumers through HealthCare.gov starting April 1. These savings will decrease premiums for many, on average, by $50 per person per month and $85 per policy per month. On average, one out of four enrollees on HeathCare.gov will be able to upgrade to a higher plan category that offers better out of pocket costs at the same or lower premium compared to what they’re paying today. 

Consumers who want to access the SEP to enroll in coverage and see if they qualify for financial help to reduce the cost of monthly premiums, can visit HealthCare.gov or CuidadoDeSalud.gov to view 2021 plans and prices and enroll in a plan that best meets their needs. Additionally, consumers can call the Marketplace Call Center at 1-800-318-2596, which provides assistance in over 150 languages. TTY users should call 1-855-889-4325.  Consumers can also find a local assister or agent/broker in their area.

Consumers who are eligible and enroll under the SEP will be able to select a plan with coverage that could start as soon as the first month after plan selection. Current enrollees will be able to change to any plan available to them in their area. To take advantage of the SEP, current enrollees should review their application and make changes, if needed, to their current information and submit their application in order to receive an updated eligibility result.

Additionally, beginning in early July on HealthCare.gov, consumers who have received or have been determined eligible to receive unemployment compensation for any week during 2021 may be able to get another increase in savings when enrolling in new Marketplace coverage or updating their existing Marketplace application and enrollment. These savings to be made available starting in early July for eligible consumers are in addition to the increased savings available to consumers on HealthCare.gov starting April 1.

The SEP is currently available to consumers in the 36 states that use the HealthCare.gov platform. Consumers served by State-based Marketplaces that use their own platform can check their state’s website to find out more information on Special Enrollment Periods in their state.

I strongly suspect the real reason for this additional extension is that it's gonna prove to take longer to update HealthCare.Gov and the various state-based exchanges for not only the expanded subsidies of the American Rescue Plan but also the changes for those on Unemployment Insurance. The actual reasons don't really matter much; in the end, the GOP may have cut off 2/3 of the "Red Leg" of the ACA's 3-legged stool, but it appears that COVID-19 is lopping off the other 1/3 of it.

Again: There's three main reasons for having a limited Open Enrollment Period in the first place:

  1. To avoid adverse selection (i.e., the same reason you can't wait until after you crash your car to buy auto insurance)
  2. To prod procrastinators into taking action; there's tons of data showing that deadlines do work to get people to actually enroll, especially younger enrollees.
  3. To make sure insurance actuaries have enough hard data to put together cost projections when they're setting premium rates for the following year.

The COVID-19 pandemic has, again, pretty much thrown reason #1 into turmoil. In fact, both America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA), which have traditionally have attempted to crack down on enrollment outside of the Open Enrollment Period, wrote a letter to the Trump Administration a year ago asking that they re-open ACA enrollment due to the pandemic. The data I've seen so far suggests that rather than causing adverse selection, those who enrolled during the various COVID SEPs last year, at least, have actually been younger and healthier than the typical Open Enrollment enrollee.

I don't know if that's continuing this spring, but the point is that the carriers will push for whatever policy they think helps their bottom line the most. If they think a shorter enrollment period will help them, they'll encourage that; if they think a longer enrollment period will help, they'll go that route.

It'll be fascinating to see what happens after the dust settles on both the COVID pandemic (I hope!) and on the expanded subsidies under the American Rescue Plan (that is, will they expire in 2 years, or will they be made permanent?) with regards to the Open Enrollment Period.