Q. I have an individual policy that I’ve had since 2011. The plan year ends in March, but it is eligible for renewal, although only through the end of the year. Do I have to renew it — at whatever rate the carrier offers me — or can I shop for a new plan instead?
A. You’ll have a special open enrollment period that begins 60 days before your renewal date and extends for 60 days after the renewal date.
HHS announced in February 2017 that non-grandfathered, pre-2014 plans (ie, transitional, or grandmothered plans) could continue to exist until as late as December 31, 2018, with renewal allowed until as late as October 1, 2018 (the decision is left up to each state, and then carriers have the final say in states that permit the extension).
So states and carriers have the option to allow existing grandmothered plans to remain in force until the end of 2018, and the majority of the states opted to allow these renewals. As a result, many non-ACA-compliant plans are once again eligible for renewal this year.
But you are not obligated to accept the renewal. HHS issued regulations in May 2014 clarifying that a non-calendar year plan renewal is a qualifying event just as a plan termination would be. This is codified in CRF 155.420(d)(1)(ii), which clarifies that the end of a plan year for a non-calendar year plan (ie, a plan with a renewal date other than January 1) will trigger a special enrollment period, regardless of whether the plan can be renewed or not. So even though your renewal date occurs outside of the annual open enrollment window, you’ll have the option to enroll in a new plan instead of renewing your existing plan.
This special enrollment period also applies to non-calendar year grandfathered plans: If your grandfathered plan renews on a date other than January 1, you can choose to renew it, or to pick a new plan at that point, using the special enrollment period triggered by the end of your plan year. ACA-compliant plans in the individual market all have plan years that follow the calendar year (ie, they renew on January 1). But that was not the case with many insurers prior to the ACA, so your grandfathered plan might have a renewal date other than January 1.
During your special open enrollment, you can shop on or off-exchange for an ACA-compliant plan to replace your existing policy. But be sure to shop in the exchange if you’re eligible for premium subsidies or cost-sharing subsidies, as those are not available outside the exchange.