MULTIPLE UPDATES: 2018 Open Enrollment is NOT over yet for (this is not a typo) 50% OF THE POPULATION.

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Yes, The Big Deadline, December 15th, has finally come and gone, and the half-length, batcrap insane 2018 Open Enrollment Period is over and done with, right?

Well...sort of.

It's true that the official deadline to #GetCovered for 2018 has passed for HealthCare.Gov (which operates 39 states), along with the state-based exchanges in Vermont and Idaho.

HOWEVER...there are 9 other state exchanges, as well as the one in the District of Columbia, which have deadlines later than December 15th:

  • Connecticut: Dec. 22nd
  • Maryland: Dec. 22nd (extended from their original deadline)
  • Rhode Island: Dec. 31st
  • Colorado: Jan. 12th (coverage won't start until either February or March, however)
  • Minnesota: Jan. 14th (enroll by Dec. 20th for coverage starting Jan. 1st)
  • Washington State: Jan. 15th (coverage won't start until either February or March, however)
  • Massachusetts: Jan. 23rd (enroll by Dec. 23rd for coverage starting Jan. 1st)
  • California: Jan. 31st (enroll by Dec. 22nd for coverage starting Jan. 1st)
  • District of Columbia: Jan. 31st (coverage won't start until either February or March, however)
  • New York: Jan. 31st (coverage won't start until either February or March, however)

Collectively, these states (+DC) represent around 95.5 million people, or nearly 30% of the entire U.S. population.

But wait, there's more!

Remember Hurricanes Harvey and Irma? Well, residents of five southern states do...and CMS issued a notice back in September that people who were residents of those states/areas when the hurricanes hit are eligible for a Special Enrollment Period between December 16th - December 31st. I'm not sure if the policies they enroll in would go into effect starting January 1st or February 1st, but the point is that these folks can still #GetCovered for 2018.

At the time, it looked like the eligible areas included 42 counties in Texas, 48 counties in Florida (most of the state), 7 counties in Georgia, and parts of Louisiana and South Carolina, although they don't seem to have any actual counties listed. However, according to Hannah Recht of Bloomberg News, the eligible areas include all of Florida, Georgia and South Carolina. I'm a bit confused about this seeming discrepancy (plus, I thought that all of Louisiana was hit hard, while it was my understanding that South Carolina and Georgia were only impacted lightly, though of course I could be wrong about this).

Note: This Miami Herald article confirms that it's all 67 counties in Florida...and Wesley Sanders (a finance director for a Georgia-based insurer) and Louise Norris (healthcare wonk and broker from Colorado) have confirmed the full-state status of GA and SC as well:

Can confirm it is the whole state of Georgia.

— Wesley Sanders (@wcsanders) December 15, 2017

And South Carolina ended up with the whole state eligible for public assistance too, so it looks like statewide SEP there too: https://t.co/eWsEFMYXFk

— Louise Norris (@LouiseNorris) December 15, 2017

In other words, that's another 35.4 million people...plus however many live in the listed counties in TX and LA. I'm not gonna go through and tally the population of every TX county, but I know the greater Houston region has over 6.3 million residents. Beaumont-Port Arthur has over 400,000 residents. Overall, I'm assuming that easily 8-9 million people live in those counties, so let's call it 44 million people total.

UPDATE: OK, apparently I was way off:

If you were affected by Hurricane Harvey, you still have time to purchase a health insurance plan for 2018. 15.8 million Texans, or 60% of the state’s population, live in counties eligible for the hurricane special enrollment period: https://t.co/MQHhNNAMTU #GetCovered #ACA pic.twitter.com/895FVWTVxz

— CPPP (@CPPP_TX) December 16, 2017

OK, so it looks like I underestimated Texas by a good 7 million people.

While I was at it, I decided to look up the actual populations of the Louisiana parishes as well, and came up with a total of  1.27 million.

Add them together and that's around 52.5 million people in designated hurricane zones who are still eligible to enroll through 12/31/17.

 

Add those to the 10 state-based exchanges above and you're up to around 140 148 million people, or 43% 46% of the population.

But wait, there's more!

Well over 200,000 Puerto Ricans have moved out since Hurricane Maria devastated the island. Most have transferred to Florida, with others scattered across other states. I'm assuming it's closer to a quarter million by now. The vast bulk of them are elgible for a 60-day Special Enrollment Period (SEP)...not necessarily because of the hurricane itself, but because they legally moved. Including these folks is a bit questionable since anyone who moves to a different rating area anytime throughout the year qualifies for an SEP anyway, but I think it counts. Of course, some of these 200K have likely already enrolled in Florida/etc. during the normal Open Enrollment Period anyway.

But wait, there's more!

As happens every year, a bunch of insurance carriers dropped out of the ACA exchanges in various states/counties nationally...my guess is perhaps 1.5 - 2 million people are currently enrolled in policies which are being discontinued on New Year's Eve. Most of these folks are going to be automatically "mapped" to a different plan or even a different carrier...but many can't be for one reason or another. All of them are eligible to take advantage of the 60-day SEP as well if they'd like to, even if they're mapped:

If your health plan will terminate at the end of 2017 and you don’t pick a new plan by the end of open enrollment (December 15, in most states), your special enrollment period continues until March 1, 2018. (That’s 60 days after your previous plan ended.)

Insurers in numerous states are leaving the exchanges at the end of 2017 or shrinking their coverage areas. If your insurer will no longer be offering plans in the exchange in your area, you’re eligible for a special enrollment period. This is true even though the exchange will map you to a plan from another insurer if you don’t select a plan during open enrollment. CMS confirmed in October 2017 that people whose plans are discontinued would be eligible for the special enrollment period, despite the fact that the exchange would automatically match these consumers to a new plan if they didn’t pick one themselves.

CMS confirmed that the special enrollment period applies in cases where an insurer exits the market in a particular area (on or off-exchange, or both), but it also applies in situations where an insurer replaces all of its PPO plans with HMOs, for example. But more minor adjustments, like changes to the deductible or copay, would not result in a special enrollment period.

Anyone who's automatically mapped, but then switches plans, has already been accounted for in the official tally already, and many of these people live in states with later deadlines anyway, but that should still leave up to perhaps 500,000 people who could potentially take advantage of the 60-day SEP.

But wait, there's more!

Under the ACA, Native Americans and Alaska Natives are not subject to the normal Open Enrollment Period time window:

There are rolling monthly open enrollment periods throughout the year for Native Americans who wish to enroll in the exchanges. They are not limited to enrolling during open enrollment. As long as they enroll by the 15th of the month, their coverage will be effective the first of the following month (there are three state-run exchanges – Massachusetts, Washington, and Rhode Island – where enrollments can be completed as late as the 23rd of the month for coverage effective the first of the following month).

There's at least 5.2 million Native Americans in the U.S. Some of them presumably live in the states listed above anyway, so there's likely some overlap...but I have to imagine that this adds at least 4 million or so to the total.

Throw in a few other oddball situations and it's safe to say that at least 145 153 million Americans, or 45% 48% of the population is still eligible to enroll...at least for another week or so.

UPDATE: Oh for Pete's sake:

I have an email in to CCIIO & I'm on hold w/ @HealthCareGov to confirm, but it looks like all of Alabama + 7 counties in Mississippi also have hurricane-related SEP thru 12/31 https://t.co/aEbG6wuHlN can anyone confirm? @hannah_recht @charles_gaba @larry_levitt @EyeOnInsurance

— Louise Norris (@LouiseNorris) December 18, 2017

Here's the FEMA website pages Norris refers to:

Autauga, Baldwin, Barbour, Bibb, Blount, Bullock, Butler, Calhoun, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Conecuh, Coosa, Covington, Crenshaw, Cullman, Dale, Dallas, DeKalb, Elmore, Escambia, Etowah, Fayette, Franklin, Geneva, Greene, Hale, Henry, Houston, Jackson, Jefferson, Lamar, Lauderdale, Lawrence, Lee, Limestone, Lowndes, Macon, Madison, Marengo, Marion, Marshall, Mobile, Monroe, Montgomery, Morgan, Perry, Pickens, Pike, Poarch Creek Reservation and Trust Lands (also FL), Randolph, Russell, Shelby, St. Clair, Sumter, Talladega, Tallapoosa, Tuscaloosa, Walker, Washington, Wilcox, Winston

George, Hancock, Harrison, Jackson, Pearl River, Stone

(Greene County is on this map for disaster designation DR-3450)

As Norris notes:

NOTE: The above list is subject to change, and there appear to be some discrepancies between the information available from CMS and from FEMA. We’re still working to confirm which counties are eligible for a special enrollment period, and will update this page as we get more information. If in doubt, contact the exchange and see if you can enroll. But even in areas where it’s available, the special enrollment period ends December 31, 2017, so don’t delay.

There also seems to be some confusion about whether or not you simply have to live/have lived in any of the listed states/counties or if you have to actually provide some sort of proof that your residence/property was damaged (?):

I'm hearing they are asking beyond county info. Specifically, flood damage. Anyone else getting this?

— Jenny Chumbley (@kgmom219) December 19, 2017

I suppose it depends on how you define "affected"? https://t.co/MWvV9TP6UE The non-subjective part of it says you have to have lived in an area declared eligible for public or individual assistance from FEMA. Still waiting for CMS clarification @wcsanders @wcsanders pic.twitter.com/c25nmki9rO

— Louise Norris (@LouiseNorris) December 19, 2017

It DOESN'T say "and you had a problem". I live in Dallas and have yet to figure out why Dallas County is listed.

— Jenny Chumbley (@kgmom219) December 19, 2017

They just say "if they experienced an SEP qualifying event" and lived in those areas. Further up the page, they say if you were "affected by a hurricane-related weather event." That's pretty subjective though.

— Louise Norris (@LouiseNorris) December 19, 2017

...and so on and so forth. Huh.

If you visit HealthCare.Gov, there's a little overlay link at the top which reads:

...which, if you click, simply says the following:

It sounds like some confusion at HC.gov's end as well, so I'd strongly recommend people double-check to be sure.

Assuming both the Alabama and Mississippi additions are accurate, that means I have to tack on another 4.86 million (Alabama) + 481,300 (7 counties in Mississippi) = 5.34 million people to the grand total, or over 158 million Americans...roughly 49% of the U.S. population.

UPDATE: Good grief. MAINE residents may qualify for an extended enrollment period now as well, due to a nasty wind storm last fall. However, Maine's status seems to be more of a "case by case basis" situation as opposed to the hurricane's "no questions asked" policy, so I'm not gonna add it to the infographic.

UPDATE 12/20/17: OK, never mind; the Maine Special Enrollment Period (SEP) is following the same "no documentation needed" rules as the Hurricane states as well:

Following Update from CMS, King Announces That Special Enrollment Period for Maine People Affected by October Storm Runs Through December 31st

Individuals Affected By October Wind Storm Do Not Need to Provide Additional Documentation To Qualify; In November, King Wrote Letter to CMS Administrator Seema Verma Requesting Extension

Tuesday, December 19, 2017

WASHINGTON, D.C. – Today, Senator Angus King (I-Maine) and healthcare assisters working to sign Maine people up for healthcare through the Affordable Care Act have received additional guidance from the Centers for Medicare and Medicaid Services, telling them that people in Maine affected by October’s wind storm can sign up for coverage through December 31st, and will not require any additional documentation to qualify. The new information provides an update to CMS Administrator Seema Verma’s response to Senator King’s request for an extension of open enrollment for affected areas of Maine.

...Per Administrator Verma’s letter to Senator King, any resident of Maine who did not secure coverage by the end of the Open Enrollment Period and was affected by the wind storm should contact the Marketplace Call Center at 1-800-318-2596 to speak with a Marketplace representative.

Add Maine's 1.33 million residents to the tally and we're up to over 159 million people, closing in on 50%.

UPDATE 12/20/17: (sigh) Thanks to Hannah Recht for confirming the following:

Hurricane Nate related eligibility also extends the SEP to residents of additional Louisiana counties, to a total of 33 LA counties.

— Hannah Recht (@hannah_recht) December 19, 2017

When I overlap the 19 parishes listed in the Hurricane Nate list with the ones I already had listed, I only come up with 32 LA parishes, but whatever. The population of these additional counties adds another 1.56 million people to the total, bringing it up to nearly 161 million Americans...or almost precisely 50% of the total population.

I've updated the infographic AGAIN to reflect the latest updates: