Open enrollment on the federal health law鈥檚 marketplace ends Friday, and most people who want a plan for next year need to meet the deadline.
But some consumers who miss the cutoff could be surprised to learn they have the opportunity to enroll later.
鈥淲hile a lot of people will be eligible 鈥 I am still worried that a lot of consumers won鈥檛 know it,鈥 said Shelby Gonzales, a senior policy analyst at the Center on Budget and Policy Priorities.
Under the health law,聽people are entitled to a (SEP) when they聽have specific changes in their lives, such as losing other health insurance, getting married or having a child, or when they have a change in income that affects their eligibility for premium tax credits or cost-sharing reduction subsidies.聽Those special enrollment periods generally last at least 60 days.
Other circumstances can also qualify customers for a聽special enrollment period.聽But this year, consumer advocates are focused on two that could affect a substantial number of people: consumers whose 2017 marketplace policies are being discontinued in 2018 and people affected by the hurricanes that ravaged Texas, parts of the Southeastern United States and Puerto Rico.
It鈥檚 not clear how many consumers this will affect. In past years, people who sign up during an SEP made up a tiny fraction of overall marketplace enrollment. In the spring of 2016, 11.1 million people had a marketplace plan. Meanwhile, roughly during 2015, according to the federal Centers for Medicare & Medicaid Services (CMS).
The majority of people who use a special enrollment period do so because they鈥檝e lost coverage under another plan. This applies to people who lose their job-based coverage as well as those with marketplace plans whose insurer discontinues their plan for the upcoming year.
Between 2014 and 2018 the average number of issuers per state , according to the Kaiser Family Foundation.聽(KHN is an editorially independent program of the foundation.) Several big name companies, including Anthem, Aetna and Humana, dramatically pulled back in their 2018 offerings.
A growing proportion of people will likely qualify for SEPs now because of a loss of marketplace coverage, insurance analysts say.
People who are eligible for that special enrollment period have up to 60 days after their coverage ends on Dec. 31 to sign up for a new marketplace plan. Meeting the regular Dec. 15 sign-up deadline is preferable because it聽allows coverage to start聽Jan 1.聽But聽eligible people who miss that date can apply through the marketplace for an SEP that will allow them to sign up until the end of February.
Even if the marketplace automatically re-enrolls customers in a plan that鈥檚 similar to the one that ended, they鈥檙e entitled to an SEP to pick a new plan, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
But people shouldn鈥檛 count on getting a clear explanation of what the SEP is or how it works, said Pollitz, who has reviewed the related to plan discontinuations.
鈥淭he notices are not what they could be,鈥 she said.
Gonzales concurs.
鈥淭he bottom line here is many consumers experienced a discontinuation of their plan this year,鈥 she said. “Notices are complicated, and these consumers in particular are going to get several notices which may result in more confusion, and it will not be easily understood by many what an SEP is or how and/or when to activate it.鈥
This year, there are also special enrollment periods for people who were affected by the hurricanes that slopped across all or parts of Texas, Florida, Georgia, Puerto Rico and elsewhere last fall.
The special enrollment period for 2018 applies to people who live in or move from counties designated by the Federal Emergency Management Agency as hurricane disaster areas. It gives them an extra two weeks, from Dec. 16 to Dec. 31, to sign up for January coverage. Officials said they鈥檒l the timeframe if necessary.
To take advantage of the special enrollment period, people must request it through the聽聽call center. They鈥檒l be asked to attest that they resided in an affected area, but they won鈥檛 have to provide proof.
Consumer advocates who work on outreach for enrollment and help people sign up for coverage aren鈥檛 yet talking up the SEPs, said Gonzales.
鈥淭hey want one clear message for everyone: Open enrollment ends Dec. 15,鈥 she said. Starting Dec. 16, these groups will start getting the word out for people who have missed the deadline and may not realize they may have other options.
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