For those consumers failing to purchase Affordable Care Act (ACA)-compliant health insurance plans during the Open Enrollment Period (OEP), there is hope. The Centers for Medicare and Medicaid Services (CMS) may offer an extension outside of the OEP’s Nov. 1, 2015-Jan. 31, 2016 window.
These Special Enrollment Periods (SEPs) provide beneficiaries with additional time to select coverage, thereby avoiding expensive tax penalties. Individuals may also qualify for their own SEPs, at any time, should they experience Qualifying Life Events; these are life changes, such as marriage, childbirth or relocation.
During the last SEP, which ran from Feb. 23 through June 30, 2015, about 944,000 beneficiaries enrolled through the the Federal Marketplace. Despite this, the government recently made major SEP-related changes, concerning their definitions and rules.
Strictly Enforcing Rules
The first area involves the elimination of certain SEPs, at the request of various insurance carriers. The Tax Season SEP, which ran from March 15-April 30, 2015, was discontinued in December; however, it was only meant for 2015. The agency plans on eliminating another six SEPs, including those for:
- Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
- Consumers affected by an error in the treatment of Social Security Income for tax dependents
- Lawfully present non-citizens affected by a system error in determination of their advance payments of the premium tax credit
- Lawfully present non-citizens with incomes below 100 percent FPL (federal poverty level) who experienced certain processing delays
- Consumers eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
- Consumers previously enrolled in the Pre-Existing Condition Health Insurance Program
To better educate consumers, brokers and issuers about possible SEP-related abuses, the CMS sought to improve the definition of certain eligibility guidelines. In particular, the agency released information concerning the SEP designed for those consumers who had permanently moved, thereby gaining access to new coverage. The CMS wanted to let it be known that these relocated consumers cannot use the SEP for short-term or temporary moves. It was thought that these people wouldn’t remain in these new locations.
Finally, the CMS addressed the enforcement and understanding of SEP rules and requirements. As such, the CMS is conducting an assessment to check if consumers that purchased policies during SEPs followed the rules. The CMS will review samples of nationwide consumer records. The agency feels that these efforts will assist in future planning and improvements. Another initiative is for Healthcare.gov applicants to provide accurate information. Those who intentionally provide false or untrue information may be subject to penalties under federal law.