CMS Makes Changes to Open Enrollment Period, Introduces New SEP

CMS has taken several steps to improve and expand access to healthcare coverage, including extending the open enrollment period for the Affordable Care Act marketplace.

The agency added 30 days to the enrollment period which will now last from November 1, 2021 to January 15, 2022. Consumers can review and choose new health plans for 2022 on HealthCare.gov during this time.

CMS also expanded its Federally-facilitated Marketplace (FFM) Navigators program. Navigators are experts who provide support for consumers in underserved communities. They can help individuals understand their benefits, review their options, and enroll in coverage.

Under the new expansion, Navigators will work to reduce health disparities by helping consumers with additional healthcare coverage topics. Consumers can receive assistance with certain post-enrollment topics, including premium tax credit reconciliation and the Marketplace eligibility appeals process.

To support this increased outreach, CMS will raise user fee rates for marketplace plans to 2.75 percent of premiums for plans on the federally-facilitated marketplace and 2.25 percent for state-based marketplace plans, according to a CMS fact sheet. However, the 2022 user fees will remain lower than the fees for 2021, CMS confirmed.

An $80 million grant from CMS will support increasing the number of Navigators to 1,500.

CMS has also announced a monthly special enrollment period on HealthCare.gov for low-income individuals, increasing the opportunity for consumers to enroll in free or low-cost health plans.

The special enrollment period will be available for consumers who are eligible for advance payments of the premium tax credit and have an annual household income of up to 150 percent of the federal poverty level, the fact sheet explained.

“Today’s action to extend the Open Enrollment Period by a month, to continue our investment in local healthcare Navigators, and to establish a special enrollment period for many low-income people further demonstrates our commitment to connect families to coverage,” CMS Administrator Chiquita Brooks-LaSure stated in the press release.

CMS indicated that it plans to re-launch its “Champions for Coverage” program, a community initiative that includes over 1,000 local organizations that provide outreach and educational resources about the marketplace.

The program informs consumers on how they can enroll and receive healthcare coverage through HealthCare.gov, Medicaid, or CHIP. The program will also employ outreach methods to boost awareness of the new open enrollment period.

“Champions for Coverage know their communities best,” Brooks-LaSure continued. “CMS is committed to listening to and working with our community partners as we embark on our most robust outreach and engagement campaign in the agency’s history.”

CMS also announced a new policy that will allow certain state Marketplaces to set their own open enrollment period end dates, as long as the end dates land on December 15, 2021 or later in the year, the press release noted.

CMS prioritized outreach and engagement for the ACA special enrollment period until its deadline of August 15, 2021. The agency, along with HHS, launched a campaign of broadcast and digital advertisements as well as text and email communications to provide resources about the enrollment period.

The agency implemented the “Summer Sprint to Coverage” campaign as well, which prioritized testimonial and traditional advertisements as well as increased outreach in underserved communities.

Similar to the special enrollment period, the expansion of the open enrollment period may potentially increase access to ACA healthcare coverage for consumers.

A recent report from HHS showed that nine in ten new enrollees who found coverage during the special enrollment period saw reductions to their premiums. The Marketplace also saw an increase in Black and Hispanic enrollees.