It’s Not Too Late: You May Still Qualify for ACA Coverage

by Obermayer Rebmann Maxwell & Hippel LLP
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March 31 was the last day to enroll in a health insurance plan through the federally-facilitated health care exchange. However, like many other Affordable Care Act (“ACA”) deadlines, the March deadline was a soft deadline, as certain consumers may receive additional time to enroll in a health insurance plan. The Centers for Medicare and Medicaid Services (“CMS”) recently released guidance pertaining to possible extended enrollment periods for consumers.   The releases, titled “Guidance for Issuers on Special Enrollment Periods for Complex Cases in the Federally-Facilitated Marketplace after the Initial Open Enrollment Period” (the “SEP Guidance”) and “Guidance for Issuers on People ‘In Line’ for the Federally-Facilitated Marketplace at the End of the Initial Open Enrollment Period” (“In Line Guidance”), outline “special enrollment periods” after the March 31 deadline for some consumers and grant relief for those consumers who were “in line” on the exchange website, HealthCare.gov, but were unable to enroll due to high volume, respectively. The deadline to enroll for those who were “in line” on HealthCare.gov is now April 15, 2014.

In technical terms, special enrollment periods do not extend the open enrollment period, rather they are specially-created periods by the government to allow certain consumers to enroll outside of open enrollment, typically due to the consumer experiencing a major life change (i.e., getting married or losing other health insurance) under authority granted by an Affordable Care Act regulation, 45 CFR § 155.420. The SEP Guidance presents information on special enrollment periods in a chart, categorizing the different special enrollment periods, providing a description of each category, and also outlining examples of what issues might fall into each category. The list below provides a few of the notable special enrollment periods:

  • Display Errors on HealthCare.gov: Where incorrect information was presented to a consumer, such as cost sharing information, the consumer should qualify for special enrollment.
  • Enrollment Error: This would arise where a consumer thought they had enrolled through HealthCare.gov, but the insurance company never received their information. Consumers experiencing this issue should qualify for special enrollment.
  • Error Messages: Where a consumer could not complete enrollment as a result of error messages on HealthCare.gov, the consumer should qualify for special enrollment.
  • Exceptional Circumstances: Consumers experiencing a natural disaster, cognitive disability or serious medical condition should qualify for special enrollment.

The In Line Guidance provides relief for those consumers who, as a result of high traffic on HealthCare.gov and also through call centers leading up to March 31, were “in line” to enroll in a health plan (i.e., attempted to enroll through Healthcare.gov or a call center), but were unable to enroll by the deadline. The relief gives such consumers until April 15 to finish enrolling in a plan, provided they pay their first month’s premium by a deadline set by their chosen insurer. This relief was anticipated (see our earlier blog post here) and is an accord with earlier relief granted back in December 2013, when consumers who attempted to enroll for coverage starting January 1, 2014 were given extra time to shop and enroll in a plan.

The Health Law Gurus™ will continue to follow issues in the implementation of the ACA.

To view the SEP Guidance, click here.

To view the In Line Guidance, click here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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