The Department of Health and Human Services (HHS) has proposed some rule changes intended to make it easier for people to enroll in health coverage. These changes include a proposed extension of the annual open enrollment period for individual/family health coverage, as well as a proposed year-round enrollment opportunity for low-income households.
This article explains these proposals, including how they came to be and what consumers can expect in terms of access to health insurance.
Focus on Expanding Health Coverage Access
In January 2021, shortly after taking office, President Biden signed Executive Order 14009, titled the “Executive Order on Strengthening Medicaid and the Affordable Care Act.”
This executive order has been a guiding force behind much of the Biden administration’s action on healthcare reform. This includes the COVID-related special enrollment period in 2021 and the administration’s support for the American Rescue Plan’s health insurance subsidy enhancements.
In June 2021, in keeping with that executive order, HHS published some new proposed rules related to the health insurance marketplaces (exchanges) and 2022 health coverage.
The rulemaking process for the 2022 year was unusual in that it happened under two separate administrations with very different ideas about how healthcare reform should be handled.
Under the Trump administration, HHS had proposed the 2022 rules in late 2020 and then finalized some of them in January 2021, shortly before President Biden took office.
Under the Biden administration, HHS finalized some of the rest of the proposed rules a few months later. But they clarified at that point that they also intended to propose some new or additional rules.
There’s a rulemaking process that must be followed. HHS has to propose the rule changes, accept public comments on the proposals, and then issue final rules.
The new proposal was issued in June 2021. It includes several provisions that would roll back rules finalized by the prior administration in January 2021. But it also includes proposals for new provisions designed to make it easier for people to enroll in health coverage.
Extending Open Enrollment Through January 15
For people who buy their own health insurance—either through the exchange or directly from a health insurance company—there’s an annual open enrollment period when coverage can be purchased.
Outside this window, a qualifying life event is necessary to have access to a special enrollment period. But during open enrollment, anyone can purchase coverage.
These same general rules apply to employer-sponsored health insurance, but employers set their own open enrollment periods, so the specific time frame varies from one employer to another.
Before 2014, there was no open enrollment window in the individual/family (self-purchased) health insurance market. People could apply for coverage whenever they wanted, but insurers in nearly every state used medical underwriting to determine eligibility and pricing.
That’s no longer the case—coverage is guaranteed issue, regardless of medical history. But enrollment without a qualifying event is also limited to the annual open enrollment period (the COVID-related special enrollment period in 2021 is an exception to the normal rules).
The specifics of the open enrollment window have varied over time. The first year, the window lasted six months. But it was gradually shortened after that, and for the last four years, it has lasted just over six weeks: November 1 through December 15.
That’s the window that applies in all the states that use HealthCare.gov as their marketplace. In DC and 14 states (increasing to 17 states in the fall of 2021), the state runs the exchange and can extend open enrollment as it sees fit. Most of those state-run exchanges tend to have longer enrollment windows each year, although it varies from one state to another.
In the newly proposed rules, HHS is calling for an extended open enrollment period. They plan to add an extra month to the end of the regular enrollment window so that it will end on January 15 instead of December 15.
If finalized, the November 1 to January 15 window would apply nationwide, starting with the open enrollment window that begins in the fall of 2021. States that run their own exchanges would still have the option to add further extensions. Some currently extend enrollment through the end of January, and they could still do that.
HHS notes that people using HealthCare.gov would still have to enroll by December 15 in order to have coverage effective January 1 (states that run their own exchanges can set their own deadlines). But people would then be able to enroll between December 16 and January 15, with coverage effective February 1.
HHS acknowledges that there are pros and cons to this. Some people might miss the deadline and end up with only 11 months of coverage instead of 12, which is not ideal. But the extended enrollment window would give enrollment assisters more time to help people enroll.
It would also give people a chance to switch their coverage after the start of the new year. This is important when a person’s coverage changes for the new year and they didn’t notice the changes in advance (this can include changes to monthly premiums, subsidy amounts, provider network, the prescription formulary, health benefits, etc.).
Under current rules, people in this situation are stuck with their coverage at that point. But if enrollment is extended through mid-January, it would give people a little extra time to pick a different plan that might better fit their needs after they notice the changes that took effect on January 1.
Year-Round Enrollment for Low-Income Households
HHS has also proposed a much more extended enrollment opportunity for low-income households. Under the proposed rules, applicants would be able to enroll in coverage year-round, as long as they are eligible for premium subsidies and their household income isn’t more than 150% of the poverty level.
For 2022 coverage in the continental United States, that would amount to $19,320 in annual income for a single person and $39,750 for a family of four (the amounts are higher in Alaska and Hawaii).
HHS isn’t sure whether this could be implemented for 2022; if finalized, it might need to wait until 2023. They are also seeking considerable public feedback on this special enrollment opportunity, asking for comments regarding the potential risk for adverse selection (healthy people avoiding coverage while sicker people choose more coverage).
They also want comments on whether this enrollment opportunity should be available indefinitely or only for as long as the American Rescue Plan’s subsidy enhancements are available (currently through 2022, but that could be extended under future legislation).
The American Rescue Plan makes benchmark silver plans premium-free (or nearly free, depending on state insurance mandates) for households with income up to 150% of the poverty level. As long as that provision remains in place, these households can generally select from among two premium-free silver plans and, in most cases, several premium-free bronze plans.
But many Americans who are eligible for these premium-free plans are not aware of the financial assistance available to them. HHS is dedicated to outreach on this topic. Still, they also feel that year-round enrollment opportunities would make it easier for people to take advantage of the available benefits.
It’s noteworthy that Medicaid enrollment already runs year-round. In most states, that means that adults with income up to 138% of the poverty level can enroll in Medicaid at any time. In the dozen states where Medicaid expansion has not been implemented, eligibility is much more limited, creating a coverage gap.
Children’s Health Insurance Program (CHIP) enrollment is also available year-round, providing eligible kids with ongoing access to coverage.
If HHS finalizes the proposed year-round enrollment opportunity for subsidy-eligible applicants with household income up to 150% of the poverty level, it will become available in states that use HealthCare.gov. The other states that run their own exchanges would have the choice to follow suit or not, at their discretion.
Rule changes proposed by the Department of Health and Human Services are aimed at making it easier to enroll in health coverage. The annual open enrollment period would be extended to January 15. They also propose year-round enrollment for households that make up to 150% of poverty level.
A Word From Get Meds Info
Throughout 2021, HHS has made it clear that expanding access to health insurance coverage is a priority. Substantial additional funding has been made available for enrollment assistance starting in the fall of 2021. HHS also wants to give people extended opportunities to enroll in coverage.
If you’re uninsured or know someone who is uninsured, it’s worth taking a moment to check out your options on HealthCare.gov. You might be surprised at how affordable the available health plans are.