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ACA Supermarkets Reopen for COVID-19

By Allison Bell

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What You Need to Know

  • Health insurers say they like the new special enrollment period.
  • HealthCare.gov managers are spending about $50 million on outreach.
  • Covered California is spending about $6 million.

The administration of President Joe Biden has drafted HealthCare.gov for the fight against the COVID-19 pandemic.

Officials at the Centers for Medicare and Medicaid Services (CMS) brought the web-based supermarket for subsidized private health insurance into full operation, for a new, pandemic-related special enrollment period that’s set to run from Feb. 15 through May 15.

The HealthCare.gov special enrollment period is open both to consumers who want new coverage and those who have already it through HealthCare.gov and want to change their coverage.

Officials estimate that about 9 million uninsured Americans, or those with overly expensive coverage, may be eligible to get an Affordable Care Act (ACA) premium tax credit subsidy support if they sign up for coverage through the special enrollment period.

Biden Support

Biden said Monday, in a statement about the start of the new special enrollment period, that he believes access to health care is a right, not a privilege.

“I will do everything in my power to ensure that all Americans have access to the quality, affordable health care they deserve,” Biden said. “That is especially critical in the midst of a deadly pandemic that has already taken the lives of more than 470,000 of our fellow Americans and infected more than one out of every 12 additional Americans, often with devastating consequences to their health.”

In the past, executives at many commercial health insurers described tight limits on HealthCare.gov enrollment periods as one of their few defenses against ending up with more than their fair share of enrollees with severe health problems.

This time around, America’s Health Insurance Plans (AHIP) is supporting the creation of the COVID-19 special enrollment period.

“That is especially true during a pandemic,” Matt Eyles, AHIP’s president, said in a statement. “We appreciate the Biden administration for providing this additional opportunity for hard-working American families to enroll in coverage for their health and financial security as they continue to fight to overcome the COVID-19 crisis.”

Eyles called the current special enrollment period a “timely and targeted” solution.

The History

Health insurers, state insurance regulators and HealthCare.gov managers originally agreed that the ACA public exchange program would offer coverage to all comers only during a limited “open enrollment period,” in an effort to give young, healthy people an incentive to pay for coverage all year round, even when they felt healthy. In recent years, HealthCare.gov has stated its annual open enrollment periods Nov. 1 and ended the open enrollment periods Dec. 15.

The District of Columbia and most of the states with locally run ACA public exchange programs began by sticking with the HealthCare.gov open enrollment period schedule, then gradually extended their official enrollment deadlines past Dec. 15. Some set the original deadlines as late as Jan. 31.

Outside of the annual open enrollment period, people typically must show they have what regulators believe to be a good excuse to be shopping for health coverage, such as the loss of employment-related coverage, to get covered.

If consumers shopping outside the usual open enrollment period do not qualify for a special enrollment period, they must wait until they next annual open enrollment period to apply for health insurance.

About 12 million people now have health coverage through HealthCare.gov or a locally run ACA public exchange, and about 2 million have individual or family major medical coverage purchased outside the exchange system.

Other people have short-term health insurance, indemnity health insurance, health sharing ministry memberships or other arrangements that are being used as alternatives to major medical coverage.

State Enrollment Period Changes

Now that HealthCare.gov has added an enrollment period on short notice, locally run exchanges have made a wide variety of special enrollment period decisions of their own.

HealthMarkets Inc., for example, is drawing traffic to its private health insurance sales website by posting a state-by-state special enrollment period chart.

At press time, HealthMarkets was showing that, as far as it could tell, exchanges in Nevada, Vermont and Washington state had not added general pandemic-related special enrollment periods.

California and Connecticut did add COVID-19 special enrollment periods.

California’s started Feb. 1 and will end May 15. Connecticut’s started Monday and will end May 15.

California and Connecticut are offering their COVID-19 special enrollment period only to consumers who are uninsured, and not to consumers who already have individual coverage and want to change their coverage.

Marketing Support

Managers of HealthCare.gov say they’ll spend $50 million on special enrollment period outreach efforts, or about $4.50 per uninsured person.

Regulators in some states that have taken a skeptical approach to ACA programs are helping to promote the new special enrollment period.

In Tennessee, for example, officials put out a press release announcing the availability of the new special enrollment period at HealthCare.gov, which in marketing materials is often branded as “the Marketplace.”

In addition to using the HealthCare.gov website and call center, “consumers can work with a network of over 50,000 agents and brokers who are registered with the Marketplace, along with over 8,000 trained assisters ready to assist consumers with their application for coverage,” Tennessee officials said.

Peter Lee, the executive director of Covered California, has long argued that spending on exchange advertising and agent support pays for itself, by attracting, younger healthier enrollees who are relatively inexpensive to cover and help participating health insurers hold down their premiums.

Covered California is spending $6 million, or about $2.20 per uninsured California resident, to promote its pandemic special enrollment period,  officials said.

Their goal is to attract what they believe to about 2.7 million uninsured California residents, including 1.2 million who are eligible for subsidized coverage through the ACA exchange program or through the state’s Medicaid program.

Agents, Brokers and Bots

Officials at HealthCare.gov and state-based exchanges have rarely disclosed detailed, channel-specific signup figures, but they have indicated that HealthCare.gov, Covered California and Colorado’s locally run exchange get about half of their enrollees through agents and brokers.

HealthSherpa, a web broker that helps agents and brokers with ACA public exchange signups, has an alert at the top of its main website informing visitors about the new COVID-19 special enrollment period in HealthCare.gov states.

Several other web brokers do not have clear special enrollment period notices on their main sites. That might be a sign that some web brokers, and, possibly, some brick-and-mortar agents and brokers, planned for the individual and family major medical open enrollment period to last only from Nov. 1 through Dec. 15.

One question is how effective web brokers, traditional producers, nonprofit assisters and health insurers’ own enrollers will be at pulling in large numbers of applications through the COVID-19 special enrollment periods.

Congress could add to the enrollment pressure. House committees have approved proposals that could lead to about 3.1 million relatively high-income people getting Affordable Care Act premium tax credit subsidies to lure them into the ACA exchange system. Those proposals might increase ACA exchange plan use by about 26%, according to Congressional Budget Office cost estimate reports.

The sudden influx of newcomers to the exchange system would further increase pressure on ACA exchange plan enrollment channels.

Roots Automation Inc. is an example of a sales technology company that hopes to benefit from what seems likely to be a squeeze on live human health insurance advisors.

The New York-based company is telling health insurers and exchange program managers that its Digital Worker team is ready and able to apply robo employee efficiency to sudden spikes in demand for exchange plan enrollment help.

Allison Bell

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