Today, President Biden signed two highly anticipated executive orders related to healthcare. The first is aimed at strengthening Medicaid and the Affordable Care Act, and directs HHS to consider creating a COVID-related special enrollment period (SEP) on HealthCare.gov. The Biden administration has also committed $50 million to outreach and education, in order to make people aware of the enrollment opportunity and the extensive financial assistance that’s available to help offset the cost of coverage and care.
State officials, insurers, and consumer advocates had repeatedly asked the Trump administration for a COVID-related special enrollment period in 2020, but to no avail. (Almost all of the state-run exchanges did open COVID-related SEPs in 2020.)
When will the HealthCare.gov special enrollment period start?
The special enrollment period runs from February 15 to August 15, giving people six months in which to pick a health plan, even if they don’t otherwise have a qualifying event (edit: this is an extension; the window was initially slated to end May 15, 2021, but was subsequently extended to August 15).
Who can use the COVID special enrollment period on HealthCare.gov?
Anyone who is eligible to use the marketplace can enroll during this special enrollment period. This includes people who are uninsured, under-insured, or already enrolled in a plan through the marketplace and wanting to switch to a different plan.
Previously, it was expected that this new special enrollment window would be aimed at Americans who are uninsured, much like the COVID-related special enrollment periods that had already been announced in the District of Columbia, Maryland, Massachusetts, and New York (and at that point, the SEP in Massachusetts also applied to people who have COBRA and would prefer to drop it and switch to a plan offered through the marketplace). But when CMS published the details of the SEP, it was clear that they wanted to cast a wide net, making the special enrollment period available for those who are without coverage, but also for current marketplace enrollees.
They’ve clarified that “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.” They also note that “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.”
So regardless of whether you’ve got no coverage at all, are already enrolled in a plan through HealthCare.gov, or have coverage under something like a short-term health plan, Farm Bureau non-insurance plan, fixed indemnity plan, healthcare sharing ministry plan, direct primary care plan, or other similar types of coverage, you’ll be able to use HealthCare.gov to sign up for coverage during this window.
Are state-run marketplaces also offering a special enrollment period for uninsured residents?
HealthCare.gov is used in 36 states, and the COVID SEP applies in all of them.
But all of the state-run exchanges have followed suit (a few had already announced COVID-related special enrollment periods prior to the federal announcement). Here’s a summary of the COVID-related special enrollment periods in states that run their own exchanges (note that this list has been updated over time to reflect new announcements and enrollment windows that have ended):
- California: Through December 31
- Colorado: Through “at least” August 15
- Connecticut: Through October 31
- DC: Through the end of the pandemic emergency period
- Maryland: Through August 15 (retroactive coverage is available, depending on when a person enrolls)
- Nevada: Through August 15
- New Jersey: Through December 31
- New York: Through December 31
- Pennsylvania: Through August 15
- Rhode Island: Through August 15
- Vermont: Through October 1 for uninsured residents; Through August 15 for people who want to change plans
- Washington: Through August 15
The other three fully state-run exchanges also implemented COVID-related special enrollment periods in 2021, but they have since ended:
- Idaho: Through April 30 (ended; a qualifying event is now necessary in order to enroll or change plans for 2021)
- Massachusetts: Through July 23 (ended; a qualifying event is now necessary in order to enroll or change plans for 2021)
- Minnesota: Through July 16 (this window has ended, but people who have received unemployment compensation in 2021 can still enroll or change to a $0 premium silver plan)
EDIT: So as of August 16, 2021, there are seven state-run exchanges where enrollment in 2021 coverage is still possible without a qualifying event: California, Connecticut, DC, Minnesota (for people receiving unemployment compensation in 2021), New Jersey, New York, and Vermont.
Some of these enrollment windows apply only to uninsured residents or people not currently enrolled through the marketplace, while others apply to anyone eligible to use the marketplace, including people who already have coverage and want to switch to a new plan. EDIT: Some of the state-run exchanges that initially started out with a limited enrollment window (ie, only for uninsured residents) have since added flexibility to ensure that people who already have coverage can take advantage of the American Rescue Plan’s enhanced premium subsidies and switch to a different plan if necessary.
In late 2020, insurance commissioners from 11 states sent a letter to President Biden, encouraging him to take various actions to improve access to health coverage and care. Opening a special enrollment period was among their recommendations, along with “restoring outreach funding, restoring flexibility on eligibility rules like failure to reconcile, and immediately revoking public charge rules.”
The insurance commissioners who wrote the letter – some whom represent states that run their own exchanges – further noted that
“many of our states run our own state-based marketplaces and we would like to work with you to ensure that any effort to encourage marketplace enrollment is truly national and therefore inclusive of state-based marketplaces, in addition to HealthCare.gov. We ask you, as soon as possible, to coordinate with state-based marketplaces on the timing of any SEP, the messaging you intend to use, and key strategies you will employ to reach the uninsured so that we can align our plans with yours.”
And the CMS press release notes that the administration “strongly encourages states operating their own Marketplace platforms to make a similar enrollment opportunity available to consumers in their states.” As of early February, only three state-run exchanges had not announced COVID-related special enrollment periods (edit: all three had announced COVID-related enrollment periods by mid-February; there are COVID-related enrollment periods nationwide, although the rules and deadlines vary a bit in some states).
How can I get coverage after the COVID-related enrollment period ends?
If you’re uninsured and don’t enroll during the COVID-related enrollment period in your state, your options for getting coverage for the remainder of 2021 will be limited.
But you likely do still have at least some options, as outlined here. If you’re eligible for Medicaid or CHIP, enrollment continues year-round, with coverage that can take effect immediately or even retroactively. Otherwise, you may have to consider a plan that’s not regulated by the Affordable Care Act, such as a short-term plan or health care sharing ministry, to tide you over until you can enroll in a plan through the marketplace.
What else will the executive orders do?
The special enrollment period for uninsured Americans is generating headlines and will be available in just a couple of weeks. But the executive order is expected to direct federal agencies to consider a variety of other reforms, which could have far more significant impact.
Among the most likely are
- restoring funding for navigators and the outreach/education work that HealthCare.gov was able to do under the Obama administration,
- rolling back the Trump administration’s relaxed rules for short-term health plans (in order to protect people with pre-existing conditions),
- no longer approving Medicaid work requirements or block grant proposals,
- rolling back the relaxed guardrails for 1332 waivers that the Trump administration championed,
- changing the way affordability of employer-sponsored plans is calculated (in order to fix the family glitch), and
- possible solutions that would eliminate the subsidy cliff and make coverage more affordable for people with income a little above 400 percent of the poverty level.
The second executive order is aimed at protecting women’s health in America and around the world, including ensuring access to all necessary reproductive health care. It rescinded the global gag rule (Mexico City Policy), which blocked U.S. funding for international non-profits that provide women with abortion counseling or referrals. The rule was first implemented in the 80s and has been rescinded and reinstated several times under different administrations.
The women’s health executive order also directs federal agencies to reconsider the Trump administration rule that eliminated federal funding for Planned Parenthood and other abortion providers.
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.