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Special Enrollment Period Trends on State ACA Marketplaces

States with special enrollment periods are boosting ACA plan marketing and may focus on populations that were unaware of coverage requirements or eligibility.

Kelsey Waddill
By
Published: 20 May 2020

State health insurance marketplaces are playing a pivotal role in helping the uninsured access healthcare coverage by opening special enrollment periods, Commonwealth Fund researchers found.

By opening special enrollment periods and launching awareness campaigns, states are making ACA plans a more viable coverage option for the uninsured, the researchers explained.

The coronavirus pandemic triggered high unemployment and, as a result, uninsurance. Some experts estimate that 27 million Americans could lose their employer-sponsored health plans and of those, 1.9 million could be left without any alternatives

Many suggest that the uninsured may turn to Medicaid and, especially in Medicaid expansion states, this is a realistic option for many of the recently uninsured. The primary alternative is for individuals to purchase a plan on the ACA’s federal or state health insurance marketplaces, which tend to have better call centers, outreach capabilities, and eligibility and enrollment platforms, the researchers pointed out.

Regardless of whether an individual chooses Medicaid or an ACA plan, the uninsured could face eligibility barriers based on income, immigration status, insurance status before the pandemic, and whether the region has a state or federal special enrollment period.

To help diminish these barriers, ACA plans are leveraging enrollment period flexibilities and outreach advantages.

All states have a special enrollment period for anyone who has lost an employer-sponsored health plan. However, some states are creating new enrollment periods specifically for coronavirus coverage.

Types of special enrollment periods

Twelve out of the 13 state health insurance markets with their own enrollment platforms have established a coronavirus special enrollment period.

The remaining 38 states rely on a federal mandate to open a special enrollment period for the federal health insurance marketplace platform, which has not yet been granted.

States have also opened special enrollment periods based on reduced-income for those with non-state-based minimum essential coverage plans or based on residence in the state.

Additionally, a handful of states have implemented special enrollment periods for populations such as:

  • Individuals who were unaware of the coverage requirements
  • Individuals who were unaware of the subsidies for which they are eligible
  • Massachusetts residents who recently qualify for the ConnectorCare program which offers premiums and subsidies to individuals with incomes up to 300 percent of the federal poverty level

State strategies for outreach

States that open special enrollment periods take a variety of approaches to alerting eligible individuals to these options.

Some states publicly advertise these options. They dedicate large amounts—in some cases the entirety—of their marketing budgets to advertising.

Other states partner with labor and employment departments to engage those filing for unemployment and let them know their healthcare coverage options on the state marketplace. New York even tries to capture individuals who have not yet lost their employer-sponsored health plans but are at-risk.

Another approach is to partner with consumer assisters and call centers.

Public response to special enrollment periods

Many states have seen definite response to these measures, the researchers found. California saw the greatest response, with a signup rate 250 percent of its 2019 enrollment during the same timeframe. Connecticut saw special enrollments up by 70 percent and the District of Columbia’s enrollment rose 66 percent compared to the same time last year.

Seven of the thirteen state health insurance marketplaces with their own state marketplace platforms have planned for their coronavirus related special enrollment periods to end in April or May 2020. The District of Columbia currently has the longest enrollment period, with an end date currently set for mid-September 2020.

There is also a growing younger demographic on the state health insurance marketplaces. Two states and the District of Columbia found that over half of special enrollment period enrollees are younger than 35.

“State marketplaces have responded effectively to the economic crisis caused by COVID-19, providing a port in the storm for those who need health insurance to protect themselves and their families,” the researchers concluded. “As the public health emergency and economic shutdown continue, marketplaces have a key role to play.”

As much as coronavirus is testing state Medicaid programs, state ACA plans are also being maximized. Ironically, states are leaning more heavily on their state health insurance marketplaces even as they are at risk of being ruled unconstitutional.

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