How Payers Use Special Enrollment Periods To Boost Coverage
State and private payers are using special enrollment periods to increase healthcare coverage as unemployment soars.
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- Health Care Service Corporation (HCSC) will be offering a special enrollment period for members of their group health insurance plans as many seek coverage in light of the growing pandemic.
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“These are extraordinary times and an extraordinary response is needed,” said Greg Thompson, HCSC spokesperson. “We are stepping up to help meet the health care coverage needs of as many people as possible by opening up a special enrollment period.”
The month-long special enrollment period is optional and began on April 1.
The enrollment period is open for two types of potential members: employees whose companies offer these plans but who chose not to enroll during the normal enrollment period, and a member’s spouse and dependents who were not enrolled onto the member’s plan during the normal enrollment period.
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The enrollment covers medical, pharmacy, and dental coverage.
“We are working closely with many providers and partners to protect the health and the safety of our employees, members, and people in the communities in which we operate,” Thompson said.
HCSC has also launched websites to inform members about coronavirus. It has waived prior authorizations and cost-sharing related to coronavirus testing as well as cost-sharing for telemedicine medical and behavioral healthcare services. Some HCSC plans also made their policies on early prescription refills more lenient.
Special enrollment is a particularly heated subject as millions of Americans lose their jobs and their healthcare coverage due to the coronavirus, yet the administration refuses to open a special enrollment period for the Affordable Care Act federal health insurance marketplace.
The Department of Labor’s Unemployment Insurance Weekly Claims update marked a record-breaking rise in unemployment claims.
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On the week ending March 28, the number of initial unemployment claims was over 6.6 million. This is almost exactly double the claims from the previous week, when the number of initial unemployment claims was more than 3.3 million.
Insured unemployment is the highest it has been since July 2013 after more than doubling in the span of a week.
Initial claims of unemployment is a significant economic indicator, but it is also an indicator of coverage rates in the health payer industry.
In the US in 2018, slightly under half of the country obtained their health insurance coverage through employer-sponsored health plans.
With such a rise in unemployment insurance claims, many Americans may be struggling to replace their employer-sponsored health plans.
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A special enrollment period like HCSC’s may allow those who still have employer-sponsored health plans to transfer their spouse and dependents to their own plan, if the household lost its other source of health insurance coverage.
Such individuals may also be able to enroll on the Affordable Care Act federal health insurance marketplace, since their job loss is counted as a qualifying life event for a special enrollment period.
However, those who are ineligible for employer-sponsored health insurance—or who did not have health insurance to begin with—find themselves in a much more precarious situation.
One option for such individuals is to find a plan on their state health insurance marketplace, if their state health insurance marketplace is offering a special enrollment period.
However, only 19 of the states run their marketplaces independent of the federal government or only use the federal government’s platform to offer their marketplace, according to the Kaiser Family Foundation’s data as of early 2020.
Of those, 11 plus the District of Columbia are extending a special enrollment period, as of late March 2020.
In the 32 states that use the federal health insurance marketplace, residents do not have the option to enroll in a federal health insurance marketplace health plan because the federal government has not opened up a special enrollment period.
Governors in states with federal health insurance marketplaces have urged CMS to open a special enrollment period (SEP) for their states.
“With no vaccine in place and a high degree of uncertainty about the direction that the virus will take, increasing access to coverage will play a role in managing this outbreak,” Governor Murphy wrote in a letter to HHS and CMS requesting a special enrollment period for New Jersey. “Similar to actions CMS has taken in the past during major weather events such as hurricanes, creating a SEP is a responsible action that will benefit individuals, as well as, contribute to the management of a public health crisis.”
According to data recently released by Covered California, California’s state health insurance marketplace, twelve marketplaces which represent 30 percent of the nation’s population have already adopted a special enrollment period for the individual market.
Nevertheless, the administration has been clear in its opposition to opening a special enrollment period for the federal health insurance marketplace.
