Special Marketplace Enrollment Period

April 30, 2021

There is a new Special Enrollment Period for consumers to enroll in a Marketplace health insurance plan, assistance available for consumers in paying for health coverage, and an upcoming funding for navigator programs. This is an opportunity to reduce the number of uninsured rural Americans and to lower premiums for those already enrolled in Marketplace coverage who qualify.

Rural areas face multiple challenges. Consumers in rural areas are less likely to have health insurance compared to those in urban areas (14.6% vs. 12.2% in 2017), and rural consumers in states that did not expand Medicaid are even less likely to have health insurance than those in states that did expand (18.0% vs. 11.1%). Rural residents also tend to have shorter life expectancies and higher prevalence of chronic conditions than those in urban areas. Compared to their non-Hispanic White counterparts, non-Hispanic Black and American Indian rural residents reported having worse self-rated health.

Enrolling more eligible people into the Marketplace at this time produces a number of benefits. It helps rural residents receive needed coverage, and it ensures that health care providers are reimbursed, which reduces their bad debt and helps their financial bottom line. Engaging in outreach and encouraging enrollment is a way to generate revenue for your community or hospital.

From now until August 15, 2021, residents who live in the 36 states that use Healthcare.gov can sign up for or change their health insurance through a Special Enrollment Period due to COVID-19. No qualifying life event, such as marriage or moving, is required, and coverage starts the first day after the month of enrollment. Residents that live in states that run their own Marketplace websites may also be offering similar options, so check your state’s website for more information.

In addition to this window for enrollment, more people will qualify for help paying for health coverage, even those who were not eligible in the past. The American Rescue Plan Act of 2021 increases premium tax credits for all income brackets for coverage years 2021 and 2022. As a result, most people will see lower premiums, and many consumers with household incomes from 100% to 150% Federal Poverty Level (FPL) would have $0 premium plans (after tax credits) available to choose from when considering their options and selecting a plan. Some households earning more than 400% of the FLP may also qualify for tax credits to help pay for 2021 Marketplace coverage as well as taxpayers who receive unemployment compensation during any week beginning in 2021.

The U.S. Department of Health & Human Services (HHS) created resources to support outreach and enrollment:

  • There is a PowerPoint presentation with a communication plan detailing target audiences and key messages;
  • cms.gov has Fact Sheets in 11 languages, social media posts, a tv ad, video, and fillable flyers that explain the Special Enrollment Period; and
  • This Fact Sheet explains the details of the American Rescue Plan Act of 2021.