Insurance Exchanges

Many tax filers who were uninsured for all or part of 2014 are learning for the first time that they must pay a penalty, and have missed the opportunity to enroll in 2015 coverage. These gaps in consumer awareness, combined with the timing of this year’s open enrollment period (OEP), have led to several Marketplaces allowing certain uninsured consumers additional time to enroll in order to avoid paying a penalty next year. The Federal government and nine State-based Marketplaces have already announced plans to establish a Special Enrollment Period (SEP) to permit individuals subject to the tax penalty to enroll in 2015 coverage outside of this year’s OEP, thereby minimizing the penalty they could incur when filing their 2015 taxes. This document, prepared by Manatt Health Solutions, provides a summary of the tax season SEPs being utilized by each of these Marketplaces.

How would a Supreme Court ruling for the plaintiff in King v. Burwell affect consumers, insurers, providers, and states? A new series on The Commonwealth Fund Blog looks at the potential real-world impact of the case being argued next week. The series will examine the consequences of a decision that would end subsidies for residents of the 34 states that have federally run health insurance marketplaces. The first post looks at how individual consumers would fare in health insurance markets that would likely function even more poorly than those that existed before the Affordable Care Act was enacted.

Analysis of Marketplace enrollment has focused primarily on the initial 2014 open enrollment period. But as the second open enrollment period ends—and as open enrollment periods shorten in future years—special enrollment periods (SEPs) will warrant increasing attention. This paper analyzes the legal framework, limited enrollment data, and first year special enrollment experiences in five State-Based Marketplaces (SBMs) and finds that Marketplace systems and consumer outreach and enrollment efforts did not yet match the significant potential for SEP enrollment. The paper identifies several themes that may help policymakers improve SEP enrollment systems in 2015 and beyond.

Private insurance plans typically require some form of cost sharing (also called out-of-pocket costs) when enrollees receive a health care service covered by their plan.  These expenses, which are in addition to the amount an enrollee spends on his or her monthly premium, come in a variety of forms, including copayments, coinsurance, and deductibles. Insurers use cost sharing to keep down monthly premiums, but cost sharing can also lead to unexpected costs for some enrollees and can be difficult to decipher when shopping for plans or reviewing medical bills. This brief shows the cost sharing in plans sold to individuals through Healthcare.gov, with a focus on the variation in the ways plans may set cost sharing for services, such as physician visits, prescription drugs, and hospital stays.