What’s the deadline to get coverage during Obamacare’s open enrollment period?

Obamacare open enrollment deadlines

Obamacare open enrollment guide

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Q. What is the deadline to enroll in health insurance coverage in the individual market?
A.  In most states, open enrollment began November 1, and ended December 15, with all plans effective January 1. In most states, there is no longer an option to switch to a different plan after the first of the year (state-run exchanges have some flexibility on enrollment schedules, and several are offering longer enrollment periods, described below).

Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event. But several state-run exchanges extended their open enrollment deadlines into January, and DC’s has been extended into February. In addition, people in parts of Georgia and Florida that were hit by Hurricane Michael can still enroll in February. Here are the details:

District of Columbia: January 31

The exchange board in DC voted unanimously to add a special enrollment period to the open enrollment period for 2019 coverage. So open enrollment in DC began November 1, 2018, and will continue until January 31, 2019.

DC residents who enrolled by December 15 had coverage effective January 1. Those who enrolled between December 16 and January 15 will have coverage effective February 1, while those who enroll in the second half of January will have coverage effective March 1.

California and Colorado: Open enrollment has been permanently extended

California has enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange. From now on, open enrollment in California will begin on October 15, and end on January 15.

Colorado’s Division of Insurance has also permanently extended open enrollment. State regulators published draft regulations in August 2018 calling for an annual special enrollment period, running from December 16 to January 15, that will be added to the end of open enrollment each year. The regulations were finalized in November 2018, so open enrollment in Colorado will effectively last 2.5 months for all future enrollment periods (November 1 to January 15).

A total of ten state-run exchanges extended open enrollment for 2019; two followed the Nov 1 – Dec 15 schedule

There are a total of 12 state-run exchanges that operate their own enrollment platforms. They are the only ones with the ability to extend open enrollment, and most of them chose to do so in past years. Ten of them extended open enrollment for 2019 coverage (and in some cases, for future years as well), including Vermont and Washington, both of which issued their extensions after open enrollment had closed.

Seven of the state-run exchanges extended open enrollment into January (and one, DC, issued another extension into February):

Three other state-run exchanges – Vermont, Washington, and Rhode Island – offered extensions but enrolled ended in those states before the start of 2019:

  • Vermont: December 21
  • Washington: December 20,
  • Rhode Island: December 31.

The remaining two states that use their own enrollment platforms followed the November 1 – December 15 schedule that HealthCare.gov used:

  • Idaho already transitioned to the shorter enrollment period last year.
  • Maryland’s exchange followed the November 1 to December 15 enrollment schedule.

Special enrollment periods for people affected by hurricanes continues into February

Exceptional circumstances can trigger special enrollment periods in the exchange. CMS issued guidance on this in August 2018, and additional guidance (with an extension for Florida and Georgia residents affected by Hurricane Michael) was issued in December 2018.

As a result of the 2018 hurricane season, residents in some parts of Florida and Georgia have additional time to enroll in coverage for 2019. And the earthquake that hit Alaska in November similarly gave some Alaska residents more time to enroll.

The special enrollment period applies to people in areas declared eligible for FEMA’s “individual assistance” or “public assistance,” and it continues for 60 days after the end of the incident period, as declared by FEMA. So the end of the enrollment period differs depending on where you are and when your area was hit by a FEMA-declared disaster.

  • Georgia: A wide swath of southwestern and central Georgia. Special enrollment period continues until February 20, 2019 (this is 60 days after the initial special enrollment period ended on December 22, 2018, which was 60 days after the FEMA-declared Michael incident ended in Georgia. The extension through February 20 was issued in December under the updated guidance from CMS.
  • Florida: 18 counties in the Florida panhandle. Special enrollment period continues until February 16, 2019 (this is 60 days after the initial special enrollment period ended on December 18, 2018, which was 60 days after the FEMA-declared Michael incident ended in Florida; as is the case in Georgia, the extention into February is a result of the updated guidance issued by CMS in December).

In Alaska, people who were living in the boroughs of Anchorage, Kenai Peninsula, or Matanuska-Susitna as of November 30 (when the earthquake ooccurred had until January 29 to enroll in a health plan for 2019.

In all cases, affected residents have to call the exchange and explain that they were unable to enroll during open enrollment (or in Florida and Georgia, by the end of the initial special enrollment period) as a result of the FEMA-declared disaster.

Open enrollment schedules: A history

For 2014 coverage, when the bulk of the ACA’s provisions were first being implemented, open enrollment lasted six months (October 1, 2013 to March 31, 2014), in an effort to give everyone enough time to get used to the new system and enroll.

For 2015, 2016, and 2017 coverage, open enrollment lasted for three months. Open enrollment for 2018 coverage was scheduled to follow the same three-month time frame that the past two open enrollments used (November through January). But in April 2017, HHS finalized a market stabilization rule that included a variety of changes ostensibly aimed at protecting the stability of the individual health insurance market.

One of the changes made by the new rule was the open enrollment schedule for 2018 coverage. It was reduced to half of what was previously scheduled, although it’s worth noting that the November 1 — December 15 schedule was already slated to take effect in the fall of 2018 (for 2019 coverage). The market stabilization rule just moved it up a year. However, the Trump Administration also drastically reduced funding for outreach, marketing, and enrollment assistance for HealthCare.gov, which is the exchange used by the majority of the states. This was certainly not what the previous administration had in mind when they scheduled the transition to a shorter open enrollment period. If anything, the shorter enrollment period requires more funding, not less.

The open enrollment window applies in the exchanges, and it also applies to plans purchased outside the exchange—with the exception of Nevada. (In Nevada, off-exchange plans—with no subsidies—can be purchased year-round, but the carriers can impose a three-month waiting period before coverage takes effect.)

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State-run exchanges have some flexibility on open enrollment schedule

The 2017 market stabilization rule noted that the November 1 — December 15 open enrollment period would apply in every state in the fall of 2017. However, they also noted that some state-based exchanges — there are 12 of them — might experience logistical difficulties in getting their systems ready for the new schedule on a fairly tight timeframe.

As such, the market stabilization rule clarified that state-based exchanges could use their own flexibility to “supplement the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.” Ten of the 12 state-based exchanges that use their own enrollment platform ultimately opted to extend open enrollment for 2018 (only Idaho and Vermont kept the December 15, 2017 end date).

As we can see from California and Colorado’s decisions to permanently extend open enrollment, states with their own enrollment platforms still have flexibility going forward. HHS has defined open enrollment as the window from November 1 to December 15, and that applies in every state. But state-run exchanges have the option to offer special enrollment periods before or after that window, in order to effectively extend open enrollment (California’s legislation adds a special enrollment period before and after the federally-set open enrollment period; Colorado is adding a special enrollment period after the end of the regular open enrollment period).

Outside of the open enrollment window, enrollment is only available with a qualifying event

After open enrollment ends, people can only purchase coverage if they have a special enrollment period triggered by a qualifying event such as:

  • Marriage (since 2017, this generally only applies if at least one spouse already had coverage before the wedding, although there are some exceptions),
  • Becoming a U.S. citizen,
  • Birth or adoption,
  • Involuntary loss of other health coverage (this allows people to select a new plan in the first two months of the year if their insurer leaves the market at the end of the previous year; see details below).
  • A permanent move to an area where new health plans are available (since July 2016, this only applies in most cases if you already had coverage prior to your move).
  • Here’s a full list of qualifying events and their associated special enrollment periods.

Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies, and special enrollment periods are necessary in order to enroll at any other time of the year. Nevada is an exception – coverage is available there outside the exchange year-round, albeit without subsidies and with a 90-day waiting period before coverage becomes effective.

In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods, and they further tightened the rules in 2017, as part of the market stabilization rule. As a result, the rules are being followed much more closely than they were in previous years, and in most states, anyone enrolling during a special enrollment period is required to provide proof of the qualifying event that they experienced

Native Americans and Alaska Natives can enroll year-round.  Applicants who are eligible for Medicaid can also enroll year-round.

Special rule for loss of coverage

If your health plan was terminated on December 31 for reasons other than non-payment of premium or fraud, you are eligible for a special enrollment period, as loss of coverage is a qualifying event. In order to take advantage of this provision, you’ll need to check the box on the application that says you’re enrolling because you lost coverage.

Here’s more about how the loss of coverage qualifying event works.

People who have on-exchange coverage with an insurer that leaves the market are mapped to plans with different insurers if they don’t return to the exchange to pick a new plan by December 15. But in most states, they’re still eligible for a special enrollment period (which continues for 60 days after the old plan ends) during which they can return to the exchange and pick a different plan.

People who have off-exchange coverage with an insurer that leaves the market are generally uninsured as of January 1 if they don’t pick a new plan for themselves by December 31, as there’s no entity available to automatically select a new plan for them. But the same special enrollment period applies to off-exchange enrollees — they have 60 days after the old plan ends to sign up for a new plan (albeit with a gap in coverage if they don’t sign up by December 31, as the earliest available effective date after that point is February 1).

In 2017 and 2018, numerous insurers exited the exchanges, leaving many people having to pick new plans. But for 2019, we’re seeing the opposite trend, with insurers joining the exchanges in many states (insurers have joined the exchanges in Arizona, Florida, Illinois, Iowa, Maine, Massachusetts, Michigan, Missouri, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, and Wisconsin). There are some shrinking coverage areas in some places — so people in the old coverage areas had to pick new plans — but even that was the exception to the rule for 2019. So there were significantly fewer people losing their coverage at the end of 2018 than there had been the previous two years.

Limited enrollment windows are normal and necessary when coverage doesn’t depend on your medical history

We frequently see people lamenting the fact that there’s a limited window in which to purchase coverage, but there are a couple points to keep in mind:

  • Limited open enrollment periods have long been the norm for employer-sponsored health insurance, which is where most non-elderly Americans get their coverage (you can’t just enroll in your employer’s plan anytime you like; you have to wait for open enrollment, unless you have a qualifying event).
  • Medicare also has limited annual open enrollment periods.
  • The individual health insurance market used to allow people to purchase coverage anytime they wanted. But the insurance company would ask a long list of medical history questions, and would decline applications from people with serious pre-existing conditions. That’s no longer the case, so the limited enrollment window is necessary to prevent people from waiting until they’re sick to enroll (which would be unsustainable, since insurance only works if there are enough healthy people paying premiums to offset the costs of the sick people).

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Shorter open enrollment is controversial

The reason the Obama Administration had planned to shorten open enrollment (the Trump Administration moved this up a year, implementing it in the fall of 2017 instead of 2018) was to ensure that as many people as possible are enrolled in coverage for the full year. In the past, open enrollment continued throughout January (or even later, in the case of the initial open enrollment periods), which meant that people could sign up near the end of open enrollment and get a plan that took effect in March.

The idea behind the new schedule is that everyone has coverage that starts in January, making people more likely to pay for a full year of coverage. The new schedule also removes the ability for people to “game the system” by signing up in November for an expensive plan, utilizing it for a planned expense (a surgery, for example) in January, and then switching to a lower-cost plan with an effective date in February or March. It also eliminates the adverse selection that would otherwise occur when people don’t plan to enroll but then find out in late December or January that they’re in need of health care.

But on the other side of the coin, there has been considerable concern among consumer advocates, brokers, and other enrollment assisters who worry that six weeks just isn’t enough time to help everyone get enrolled. The new open enrollment period mostly overlaps with open enrollment for Medicare Advantage and Medicare Part D, and many of the brokers who help people enroll in individual market plans are also helping people enroll in Medicare during the same time, stretching their resources.

There have also been concerns that the shorter open enrollment period might mean that fewer young, healthy people will enroll in individual market coverage. Sick people tend to enroll as soon as open enrollment begins, so they’ll enroll regardless of the schedule. But young, healthy people — the people who are needed in order to keep the risk pools stable — are more likely to procrastinate and enroll at the last minute. The shorter open enrollment period might mean that they just don’t enroll at all, with total enrollment ending up lower than it would have been with the longer enrollment period.

But despite the shorter enrollment period and the funding cuts that the Trump Administration made for marketing and enrollment assistance, enrollment in plans for 2018 was only slightly lower than it had been the year before. Almost 11.8 million people enrolled in exchange plans for 2018, versus about 12.2 million for 2017.

For 2019, enrollment ended only a little lower, at about 11.4 million, despite the fact that the individual mandate penalty has been eliminated. The Congressional Budget Office projected that 3 million fewer people will obtain coverage in the individual market in 2019 as a result of the elimination of the mandate penalty. And while off-exchange enrollment may well have dropped precipitously, on-exchange enrollment only dropped by a few hundred thousand people.

In addition, the Trump Administration has finalized rules that expand access to short-term health insurance plans and has also finalized a rule that expands access to association health plans. Both types of coverage will be more likely to appeal to healthy people, which could have resulted in fewer people signing up for ACA-compliant health plans during open enrollment for 2019 coverage. But again, many of those individuals may have had coverage in the off-exchange market prior to 2019, so their enrollments and plan changes are not as closely tracked.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Source: https://www.healthinsurance.org/faqs/what-are-the-deadlines-for-obamacares-open-enrollment-period/

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