Think ACA Exchange Enrollment Is Over Until November? Think Again.

Just more than a week ago, the White House and President Obama took a victory lap after HHS revealed that 7.1 million U.S. residents had signed up for coverage through the Affordable Care Act’s health insurance exchanges.

Considering all the attention around and celebration of the initial enrollment number, some people might think the exchanges are now closed for enrollment this year.

For many people, there is a “lock out period,” when they won’t be able to purchase coverage through the exchanges, at least until November.

However, for many others, there are two distinct ways to enroll in coverage through the exchanges outside of the initial open enrollment period. “Road to Reform” takes a look at the options for additional enrollment before November and what they might mean for overall enrollment figures.

Option 1: Enrollment Extensions

CMS announced the first way consumers can continue to enroll in the exchanges the week before the end of the initial open enrollment period. In a memo, the agency detailed a decision to provide an extension for visitors to exchange websites who tried to sign up for a health plan but ran into technical difficulties. HealthPocket recently released a comprehensive list of the extensions.

Generally, most states have followed the federal government’s lead, allowing people to enroll until April 15. However, other states, such as Colorado and Nevada, are giving residents as long as until the end of May to enroll.

Option 2: ‘Special Enrollment Periods’

Meanwhile, less attention has been paid to a second way people can continue to enroll in coverage. Just like most employees can change their health coverage because of qualifying life events, the ACA features “special enrollment periods,” or SEPs. U.S. residents experiencing basic life changes, such as having a child, getting married or losing other coverage, can qualify for an SEP.

However, individuals also can qualify for SEPs for more complex situations. For example, people who were prevented from enrolling in coverage during the original open enrollment period because of a natural disaster or a serious medical condition, such as a “temporary cognitive disability,” qualify for an SEP.  Or, if misconduct from a “non-Marketplace enrollment assister,” such as “an insurance company, navigator, certified application counselor, or agent or broker” resulted in an individual not getting coverage, being enrolled in the “wrong plan” or not receiving a federal subsidy for which they qualified, that individual can qualify for an SEP.

People who qualify for an SEP will have 60 days from the date of the qualifying event to enroll in coverage.

(Note: Medicaid is open for enrollment on a rolling basis, so qualified individuals can enroll at any time throughout the year.

How Will Extensions, Exceptions Affect Exchange Enrollment?

According to estimates by Charles Gaba, who runs the increasingly popular ACAsignups.net website, the extensions that CMS and states are affording consumers who encountered technical problems will prompt 700,000 to 900,000 more individuals to enroll. That means total exchange enrollment will hit 7.8 million to eight million by April 15.

As for the SEPs, according to some estimates, as many as 30 million U.S. residents could qualify in one way or another. However, it’s difficult to predict precisely how many of those people will sign up for coverage. Paul Van de Water, a health policy expert at the Center on Budget and Policy Priorities, told Politico, “Since this is terra nova, any estimate would be pure guesswork.”

The Congressional Budget Office predicts that by the end of the 2015 enrollment period, 13 million people will have signed up for coverage through the exchanges. Given that the 2015 open enrollment period is half as long as the 2014 period, CBO must be assuming that a good number of those who sign up between now and then will be affected by either the open enrollment extension or an SEP.

Will Anyone Still Pay Attention?

Perhaps a better question than pondering effects on enrollment is whether there will still be as much attention on the exchange sign-ups now that the initial enrollment period is over. For the next six days, eyes will be on the enrollment numbers, in part because any sign-ups during that time still will count toward the initial enrollment figure.

However, once the federal extension and the majority of states’ extensions end that attention is likely to diminish. As Gaba predicts, “for most people, watching the numbers change will lose their interest” because “there are other things to talk about, after all.”

Interest could spike if it turns out that many people who signed up for coverage do not end up paying for their premiums — as many critics of the law have noted could happen. Various estimates have put the rate of people who have not yet paid their first month’s premiums at 15% to 20%, which could lower the final enrollment tally by more than one million individuals.

And speaking of critics, attention on enrollment figures could persist because of Republicans’ continuing efforts to dismantle the law. For supporters of the ACA, an upward trend in enrollment could foster the argument that the law is successful and essentially integrated into the health system.

Around the Nation

Here’s a look at what else is making news on the road to reform.

The Netflix exchange. Recent research by Columbia Business School professor Eric Johnson found that about 80% of consumers will choose a more costly health insurance plan than they need. In this Fortune piece, Johnson examines how the ACA’s exchange websites could use a Netflix-type model, in which the site suggests coverage options for its users, to ensure they get what they need.

The truth of it. Tampa Bay TimesPolitiFact examined President Obama’s recent claim that more than three million young adults have benefitted from the ACA provision that allows them to stay on their parents’ coverage until age 26.

Medicaid & Mentally Ill. According to the Detroit Free Press, an American Mental Health Counselors Association report found that about 3.7 million U.S. residents with mental illnesses or substance use disorders would have been eligible for Medicaid coverage under the ACA’s Medicaid expansion but still are uninsured because they live in states that have not expanded the program. Meanwhile, about three million people with those conditions live in states that have expanded Medicaid and are now covered. 

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