The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year (actually, it's the year after the following year, since the final rule is generally released in mid-December).
HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements
There Are Just a Few Days Left for Friday Health Plans Customers to Avoid a Gap in Coverage
08/29/2023
Customers must enroll in a plan by this Thursday to have coverage that starts Sept. 1
DENVER— Friday Health Plans customers have less than three days to choose a new health insurance plan before their current health insurance coverage ends. Last month, the Colorado Division of Insurance announced that it had asked the courts to move Friday Health Plans into liquidation, ending coverage for all Friday Health Plans customers on August 31, 2023. Connect for Health Colorado, the state’s official health insurance marketplace, continues to urge Friday Health Plans customers to sign up for a new plan on or before this Thursday, August 31, to avoid a gap in coverage.
So far, about 46 percent of these customers have picked a new plan*
DENVER— Friday Health Plans customers have about two and half weeks* to choose a new health insurance plan before their current health insurance coverage ends. Connect for Health Colorado, the state’s official health insurance marketplace, is urging Friday Health Plans customers to sign up for a new plan before the end of the month to avoid a gap in coverage.
*Note that this press release was issued 9 days ago, so CO Friday enrollees actually only have 8 days left.
DENVER— Today, the Colorado Division of Insurance (DOI) announced that they have asked the courts to move Friday Health Plans of Colorado into liquidation, which will end coverage for Friday Health Plans customers on August 31, 2023.
Chief Executive Officer of Connect for Health Colorado, Kevin Patterson, released the following statement:
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
Individuals losing eligibility for MaineCare can enroll in plans on CoverME.gov through July 31, 2024
AUGUSTA— The Maine Department of Health and Human Services (DHHS) announced today the launch of a Special Enrollment Period (SEP) through CoverME.gov, Maine’s Health Insurance Marketplace, to help Maine people transitioning from MaineCare coverage after the COVID-19 pandemic explore affordable health insurance options and avoid gaps in coverage. The Special Enrollment Period began on April 15, 2023, and will continue through July 31, 2024, allowing Maine individuals found no longer eligible for MaineCare to apply for plans through CoverME.gov outside of the annual Open Enrollment Period.
According to the essential Louise Norris, there are currently just six states where being pregnant in and of itself makes someone eligible for a Special Enrollment Period outside of the official Open Enrollment Period:
In most states, pregnancy does not trigger a special enrollment period. HHS considered this, but clarified in 2015 that they had decided not to include pregnancy as a qualifying event. This means that in most states, the special enrollment period tied to having a baby does not begin until the baby is born.
But state-run exchanges (there are 18 of them as of 2022) can set their own rules for qualifying events and special enrollment periods. Some of them do allow a special enrollment period triggered by pregnancy. This gives a pregnant person access to health coverage during the pregnancy, rather than having to wait until the baby is born to obtain coverage. As of 2022, pregnancy is a qualifying event in the following state-run exchanges:
As I noted this morning, while the 2023 ACA Open Enrollment Period has now officially ended in all states, there's still a lot of Special Enrollment Period (SEP) exceptions for people who have Qualified Life Experiences (QLEs) such as losing their current coverage, turning 26, moving, getting married/divorced, giving birth and so forth.
There's also year-round enrollment available for members of Native American tribes, as well as those eligible for Medicaid and the Children's Health Insurance Program (CHIP).
Finally, in most states, residents are eligible to enroll year-round as long as their income is below a certain threshold--usually 150% of the Federal Poverty Level (FPL), somewhat higher in some states, including New York, where residents earning. up to 200% FPL can enroll in the Essential Plan year-round.
