By Megan Houston, Georgetown University Center on Health Insurance Reforms
On November 1, the eighth open enrollment period begins for marketplace coverage under the Affordable Care Act. This year there are several policy changes that could have an impact on enrollment and affordability of plans on the marketplace including:
- COVID-19 Pandemic: The novel coronavirus (COVID-19) pandemic and resulting social distancing policies have led to economic and social disruption, causing many to face the loss of employment, income, and/or their source of health insurance. There are a number of policy changes related to the pandemic that can impact enrollment and affordability on the marketplace.
- Some states that run their own marketplace may have established additional special enrollment periods due to the COVID-19 pandemic, so check with your state marketplace to see if you qualify.
- Some insurers have offered premium discounts or rebates to policyholders in 2020, because of the reduced amount of claims during the pandemic. However, under new federal guidance these discounts or rebates should not change consumers’ eligibility for premium tax credits, nor affect the tax reconciliation process.
- In August of 2020, federal funds became available to supplement unemployment insurance payments. Consumers in almost every state filing for unemployment insurance due to the COVID-19 pandemic were eligible to receive an increase of $300 per week to unemployment benefits (possibly up to an additional $400 in some states) for a limited time period. While the federal government hasn’t provided clear guidance on how this will be counted for purposes of determining marketplace subsidy eligibility, federal guidance indicates the additional $300 is not included in assessments for Medicaid and CHIP eligibility (treatment of the additional $100, if available, has yet to be determined for either subsidy or Medicaid eligibility determinations).
- Public Charge Rule: Beginning February 24, 2020, the current test to determine a person’s application for admission to the U.S. or permanent residency expanded. Previously, only an applicant’s use of two public benefits – cash assistance and institutional long-term care – were negatively considered when making a public charge determination. The Trump Administration expanded this policy to include an individual’s application for health programs such as Medicaid (with some important exceptions including receipt of Medicaid for children under 21) and the Supplemental Nutrition Assistance Program (SNAP) as factors for consideration. Application and enrollment in marketplace coverage and the application for and use of premium tax credits and cost-sharing reductions, however, will not be negatively factored into the public charge test. Though this rule has been finalized nationwide, the expansion has been blocked in New York, Connecticut and Vermont. To learn more about this policy, see this FAQ.
- ACA Litigation at SCOTUS: The constitutionality of the Affordable Care Act (ACA) will again be considered by the United States Supreme Court. A decision on this case is not expected until Spring 2021 and until that happens the ACA’s insurance reforms, the marketplaces, and federal financial assistance remain in place. For more information see this FAQ.
- New Special Enrollment Period (SEP) for Individuals Newly Eligible for Advanced Premium Tax Credits (APTCs): In prior years, individuals who were covered under an employer-sponsored plan or a plan purchased through the marketplace could access a SEP if they became newly eligible for APTCs. However, individuals who purchased an individual market plan outside of the marketplace (“off-marketplace”) could not. In 2020, HHS expanded this opportunity to allow individuals who are enrolled in an off-marketplace plan and who experience a decrease in income that makes them newly eligible for APTCs to use a SEP to enroll in an on-marketplace plan. However, this may not be immediately available in all states, and consumers may have to contact the marketplace call center to access the opportunity. See this FAQ for more information.
- Retroactive Effective Dates: CMS has streamlined its rules and processes for retroactive coverage for consumers who receive a special enrollment period, a favorable appeal decision, or a processing delay. Consumers have the option to pay the premiums for all the months of retroactive coverage, or only pay the premium for one month of coverage and receive prospective coverage only.
- SEP for someone with an Enrolled Dependent: CMS has adopted new policies to make it easier for an individual who qualifies for a SEP to enroll into a dependent’s marketplace plan. The marketplace will allow the individual to be added to his or her dependent’s current health plan. If the current health plan does not allow for this, the individual and their dependent(s) can switch to a different health plan within the same level of coverage, or he or she can enroll in a separate health plan.
- Two Payment Rule for Abortion Services: A federal judge has enjoined a Trump Administration regulation that requires insurers to send two separate monthly bills, one for abortion coverage and one for coverage of all other services. Pending the outcome of this litigation, consumers are still able to pay their monthly premium a single transaction.
- Contraception Mandate: In July of 2020, the U.S. Supreme Court ruled that federal rules expanding exemptions to the ACA’s contraceptive coverage requirement could go into effect. These rules, previously subject to a nationwide injunction, allow eligible organizations including employers, insurers, and universities to exclude contraceptive coverage on the basis of “sincerely held religious beliefs or moral convictions.” While previously, the federal government required these entities to provide an accommodation so that plan enrollees could still access contraceptive coverage, that accommodation process is now optional. Some plan enrollees may now have to pay entirely out-of-pocket for contraception. The rules are subject to further legal proceedings. Enrollees should check with their plan administrator to see if their benefits are impacted – see our FAQs for employees and students.
We have more information about these policy changes as well as hundreds of frequently asked questions about marketplace enrollment in our newly updated Navigator Resource Guide, set to relaunch shortly before open enrollment. The Guide features updated and new frequently asked questions, a 50-state resource page with state-specific information about eligibility and enrollment, and an “Ask the Expert” feature to give navigators and consumers help troubleshooting complex enrollment questions. Stay Tuned!
[This post originally appeared on the Center on Health Insurance Reforms blog. CCF’s Tricia Brooks contributes to the Navigator Resource Guide and “Ask the Expert” feature.]