After considering reopening the Healthcare.gov markets for several weeks, Fox News reports the Trump administration there will be no SEP for Healthcare.gov amid coronavirus outbreak. Reopening the markets would have enabled millions of workers, and people who chose not to buy during open enrollment, to purchase health insurance. This decision came despite pressure from both Republican and Democrat members of Congress and Governors of several states in favor of the special enrollment period. Insurers, health care providers and consumer groups, including American Diabetes Association, Families USA and the New Hampshire Nurses Association, wrote a letter to the administration asking it to create a special sign-up window as the health crisis spurs mass layoffs in the country.
What is a Special Enrollment Period?
The option to reopen the markets (outside of open enrollment) is known as a special enrollment period, or SEP. In the past, the administration has established a SEP in the wake of natural disasters, such as the 2017 and 2018 hurricanes. The decision, however, does not prevent Americans with employer-based health insurance who recently lost their job from obtaining health insurance if they want it. Under current law, people who lose job-based insurance already qualify to enroll on the marketplace but must prove that they lost their coverage. A special enrollment period would have made it easier by not requiring that paperwork. In addition, people who chose not to buy health insurance this year but want it now would have been eligible to participate. Not reopening Healthcare.gov means millions of uninsured Americans will remain shut out from the marketplaces until they reopen in the fall.
States Establish Their Own SEP
California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Washington and District of Columbia all control their own marketplace and have established special enrollment periods to allow people to obtain new insurance coverage. Federal approval would have been required for the remaining 38 states using Healthcare.gov to allow residents to buy new insurance.
Why the Rejection?
Fox News reports “Americans with employer-based health insurance who contract severe cases of COVID-19 could end up with out-of-pocket expenses that top $1,300, the Peterson-Kaiser Family Foundation Health System Tracker found. The cost could surge above $20,000 for uninsured Americans.” Considering the potential cost of treating the coronavirus, why is there no SEP? The reason for the administration’s refusal to reopen the Healthcare.gov marketplace has not been made entirely clear. Fox News reports one official told The New York Times the White House was divided about whether to proceed with establishing a special enrollment period, given Trump’s support for a federal lawsuit that would rule the entire law unconstitutional. The president has said he is considering using federal programs like Medicare and Medicaid to provide coverage for uninsured citizens. As of April 3, there have been no forthcoming proposals for this alternate solution.
As we continue on this coronavirus journey, remember to keep your health and your clients’ health, at the forefront. If your clients do not qualify for an existing SEP on Healthcare.gov a short-term plan may be the right solution for them.
Empower Brokerage is dedicated to helping you educate your clients on the insurance they need to get the most out of life. Whether it’s through webinar training, one-on-one calls, seminars, or marketing plans. We want you to be successful. Give us a call if you have any questions 888-539-1633.