Changes that the Department of Health and Human Services (HHS) proposed in special enrollment periods (SEPs) and the dates for the upcoming open enrollment period for 2018 coverage were finalized and became effective on June 19, 2017.
States and State-Based Marketplaces that do not rely on Healthcare.gov have some additional flexibility related to several provisions of the rule.
↓ Read the final rule
Overview of changes to SEPs include:
Prior coverage requirement for Marriage SEP. To be eligible to enroll in coverage or change plans using the SEP triggered by marriage, at least one spouse must have had at least one day of minimum essential coverage in the 60 days prior to the marriage.
Restrictions on plan selection for current Marketplace enrollees who are eligible for an SEP. If a person already enrolled in Marketplace coverage is eligible for an SEP, they can only use that SEP to change plans within the same metal level as their current plan, except in some limited cases. (This is in contrast to the current rules, which permit enrollees experiencing an event that triggers an SEP, and their dependents when applicable, to change to any Marketplace plan at any metal level.)
In addition, under the new rule, if an enrollee gains a dependent or gets married, that enrollee generally cannot change plans. The enrollee can either add the new dependent or spouse to his or her current Marketplace plan, or enroll the new dependent in a separate plan. In rare cases where an enrollee’s current plan does not cover dependents, the enrollee and dependent can choose to enroll in a new plan together within the same metal level as the enrollee’s current plan.
Pre-enrollment verification for SEPs. Beginning in late June 2017, some people enrolling through an SEP will not be able to effectuate their coverage until the Marketplace verifies their eligibility for an SEP qualifying event.
The process will be phased in over the course of the year and will apply to the most common SEPs, including loss of other coverage and permanent move, when the rollout is scheduled to begin June 23, 2017. Pre-enrollment verification will eventually apply to all people newly enrolling in Marketplace coverage and to all categories of SEPs.
- State-Based Marketplaces that do not use Healthcare.gov are not required to conduct pre-enrollment verification of SEP eligibility.
Overview of other changes include:
Shorter open enrollment for 2018 coverage: Open enrollment will run from November 1, 2017 through December 15, 2017, allowing only 45 days to apply for and select a plan for 2018.
- State-Based Marketplaces can have a longer open enrollment period by adding a supplemental special enrollment period.
Change to guaranteed availability rules regarding prior premium debt: Allows an insurer to refuse to enroll a person who owes back premiums to the insurer from the past 12 months, unless and until the person pays the prior premium debt. This change is subject to state law, which may prohibit this practice.
Special Enrollment Period Reference Chart | View resource
Webinar: Overview of Changes in the Marketplace | View webinar
Webinar: Changes to SEPs and Pre-Enrollment Verification | View webinar