The 2022 Affordable Care Act marketplace enrollment period will increase from 45 to 75 days this year, and states will have the option to allow people with low incomes to sign up for coverage year-round, the Biden administration announced Friday.
Over the objections of Obamacare marketplace insurers, a final rule by the Centers for Medicare & Medicaid Services (RIN 0938-AU60)
extends the marketplace open enrollment period from Nov. 1 to Jan. 15, 2022, for states that use the HealthCare.gov website. Enrollment previously ended on Dec. 15.
States that use their own insurance marketplaces and enrollment platforms can establish different end dates for the annual enrollment period—as long as they conclude on or after Dec. 15, 2021, the CMS said.
In addition, the rule allows states to establish a monthly special enrollment period for people eligible for advanced premium tax credits whose projected annual household income is no greater than 150% of the federal poverty level. Under current rules, these people must now must experience a qualifying life event or wait for the annual open enrollment period to get coverage.
The rule also reinstates a requirement that navigators—which assist people in obtaining coverage—inform consumers on post-enrollment topics, such as the marketplace eligibility appeals process and the basic concepts and rights of health coverage and how to use it, a CMS statementsaid.
Marketplace enrollment is currently at an all-time high with 12.2 million people signed up for coverage.
“Today’s action to extend the Open Enrollment Period by a month, to continue our investment in local health care 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 said in a statement.
In public comments for the new rule, marketplace insurers argued the expanded enrollment period would invite “adverse selection,” in which healthier enrollees delay signing up for coverage until the last minute, while sicker people would enroll earlier, thus increasing costs and premiums.
But consumer advocates say the longer enrollment allows people who are automatically re-enrolled into coverage to re-evaluate their options and select a new, more affordable plan after they’ve received updated cost information in the new coverage year.
Insurers also opposed the CMS plan for a new monthly special enrollment period for adults and dependents who are eligible for advance premium tax credits—and whose household income is less than 150% of the federal poverty level. The new rule would allow them to enroll in marketplace coverage whenever their income or eligibility permits.
The new rule is designed to help people who lose Medicaid coverage, a population that’s sure to increase when the pandemic health emergency is lifted. But America’s Health Insurance Plans had argued in a public comment letter that “constant enrollments and disenrollments would undermine the stability of the individual market and could result in higher premiums, narrower networks, and limit consumer choice.”
In addition, the final rule:
- Repeals a requirement that marketplace plans send a separate bill for the portion of a policyholder’s premium “attributable to coverage for abortion services for which federal funding is prohibited,” a CMS statement said.
- Repeals the Exchange Direct Enrollment option that allowed state-based marketplaces to facilitate enrollment “primarily through private-sector direct enrollment entities,” including “web brokers, agents, and brokers, rather than the Marketplace’s centralized website.”
- Increases the federal marketplace user fee rate to 2.75% of premiums and the state-based marketplace user fee rate to 2.25% of premiums. “This is an increase from the previously-finalized rates of 2.25% and 1.75%, respectively. The increased revenue will help fund consumer outreach efforts and the navigator program,” the CMS said.