On March 27, 2014, we listed the 10 additional categories of special enrollees that may enroll in coverage in the Federally-facilitated Marketplace (“FFM”) after open enrollment. Well, in the meantime, HHS has added 4 more to the list. How can HHS do this? 45 CFR 155.420(d)(9) provides that a Health Insurance Marketplace must provide a special enrollment period when “[t]he qualified individual or enrollee, or his or her dependent, demonstrates to the Marketplace, in accordance with guidelines issued by HHS, that the individual meets other exceptional circumstances as the Marketplace may provide.” HHS simply must make a determination that a class of individuals will experience exceptional circumstances regarding health coverage, and that class will be added to the special enrollment list.
Here is a summary of the new special enrollment classifications based on HHS’ exceptional circumstances determination and the corresponding enrollment deadline.
|Exceptional Circumstance Classification||Special Enrollment Deadline|
|Individuals, and their dependents, losing coverage by virtue of the Pre-Existing Condition Insurance Program (“PCIP”) termination||Must enroll by June 30, 2014|
|Individuals whose individual market plans are renewing outside of open enrollment||60 days from the individual’s renewal date or FFM notice of non-renewal to enroll|
|Individuals who are beginning service in AmeriCorps and National, VISTA, or MCCC programs||60 days from state date to enroll|
|Individuals who are concluding their services in the AmeriCorps State and National, VISTA, or NCCC programs and are losing access to short-term limited duration coverage or self-funded coverage||60 days from last day of service to enroll|
There has also been some confusion as to how having COBRA coverage affects an individual’s coverage options after open enrollment. See CMS May 2, 2014, Guidance Material. During open enrollment, individuals with COBRA coverage may voluntarily drop their coverage and enroll in Marketplace coverage, regardless of whether COBRA coverage has expired. After the open enrollment period, if an individual’s COBRA coverage expires, they would qualify for a special enrollment period and would have 60 days to purchase Marketplace coverage. See 45 CFR 155.420(d)(1). For 2014, individuals eligible for COBRA coverage and COBRA beneficiaries have until July 1, 2014, to enroll in Marketplace coverage. After that, if an individual cancels COBRA coverage outside of open enrollment, they would not qualify for a special enrollment period, unless some other qualifying event occurs.
As evidenced by the May 2, 2014 revised COBRA Election Notice, however, HHS wants COBRA eligible individuals to “strongly” consider purchasing coverage through the Marketplace. The revised Notice includes pro-Marketplace language such as:
You may be able to get coverage through the Health Insurance Marketplace that costs less than COBRA continuation coverage. (emphasis in original)
Instead of enrolling in COBRA continuation coverage, there may be other more affordable coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.”
You may be able to get coverage through the Health Insurance Marketplace that costs less than COBRA continuation coverage. You can learn more about the Marketplace below. [followed by a description of the Marketplace] (emphasis in original)
Coverage through the Health Insurance Marketplace may cost less than COBRA continuation coverage. Being offered COBRA continuation coverage won’t limit your eligibility for coverage or for a tax credit through the Marketplace.
You always have 60 days from the time you lose your job-based coverage to enroll in the Marketplace. That is because losing your job-based health coverage is a “special enrollment” event.
To find out more about enrolling in the Marketplace, such as when the next open enrollment period will be and what you need to know about qualifying events and special enrollment periods, visit www.HealthCare.gov.
The revised COBRA General Notice also notifies individuals that other, cheaper coverage options may be available through the Marketplace.
We expect to see more special enrollee classifications and revisions to the COBRA Notice. Stay Tuned.