Enrollment Changes and Updates on ACA

Though the initial enrollment period for the Affordable Care Act ended March 31, those who missed it will have to wait for the next open-enrollment period beginning in November...most likely.

This may cause some people who did not register by the deadline to feel they have missed an opportunity, and it should be noted that individuals who had technical difficulties with the Healthcare.gov website had their deadline extended to mid-April. Other individuals seeking to enroll under the Affordable Care Act may still have the opportunity to enroll outside of the standard enrollment periods, even if they had no difficulty trying to enroll before. It all depends on whether or not they qualify for certain life-event exceptions.

What are these life events?

Qualifying life events that allow an individual to enroll under the Affordable Care Act outside the predetermined periods include any of the following:

  • Relationship status changes – This applies to individuals who become married or divorced.
  • Changes in dependents – Families or persons who add a dependent to their home can change their health care enrollment. This applies both to people who had a baby and those who have adopted.
  • Loss of the existing health plan – This may occur for any number of reasons. A person may move to a new state where the plan is no longer applicable, or perhaps a plan is discontinued by an employer, leaving a previously insured individual to search of a new plan.
  • Changes in income – Individuals who experience a change in income also qualify as experiencing a life event. This change can include becoming unemployed, laid off or even having one’s hours reduced.

People who qualify for any of these events have 60 days from the date of the event to enroll and select their new plan. Early evidence points to life event plan transitions as having a noticeable effect on the marketplace. Michael Z. Stahl, senior vice president at Broker HealthMarkets Insurance Agency, reports that their own internal analysis shows half of the agency’s business came from such events.

What about Medicaid?

As the MBACC site explains "The original intention of the ACA was to cover any individual under the age of 65 who earns at or below 133% of the Federal Poverty Level (FPL) through an expansion of state-sponsored Medicaid programs." They go on to say that this is the first time low-income individuals that do not have children were able to qualify for Medicaid though states have the choice to opt out of the Medicaid/CHIP expansion as designed under the ACA. Persons eligible for the Medicaid program do not need to worry about life events or plan enrollment dates, as they are not applicable to the Medicaid program.

Learn more details about the ACA
Visit the MBACC (Medical Billing and Coding Certification) website at: http://www.medicalbillingandcodingcertification.com/health-insurance-guide/affordable-care-act/

Changing of the Guard

Shortly after the enrollment period ended, embattled Department of Health and Human Services secretary, Kathleen Sebelius, resigned. Her resignation was announced April 11.

As secretary of the department, Sebelius was responsible for the roll out of HealthCare.gov drawing criticism from opponents for the rocky way the site debuted. Problems began with extending the launch dates but continued as site and enrollment issue became more apparent and frequent. As with any major site development there are several third party companies. Initially the work began with CGI Federal Inc. and their subcontractors which then led to the involvement of Experian, Quality Software Services Inc., Accenture, and assistance from Oracle, Red Hat, and even Google.

Enrollment in the ACA had surpassed 7 million, though, when Sebelius resigned from her position and White House officials said she resigned of her own accord. She first became secretary of the Department of Health and Human Services in April of 2009. Before that she had served as a state insurance commissioner and as the governor of Kansas.

Burwell Nominated as Replacement

Sylvia Mathews Burwell, the current director of the Office of Management and Budget has been nominated to replace Sebelius as the secretary of the Department of Health and Human Services. Burwell was confirmed as director of the Office of Management and Budget in April 2013 as the United States Senate voted 96-0 in confirmation. Burwell has previously worked for the Walmart Foundation and the Bill and Melinda Gates Foundation. She also served in the Clinton Administration under former Treasury Secretary Robert Rubin.

With six months to go before the next enrollment period opens, it will be interesting to see what further changes develop and how the plan’s offerings and enrollment shape up for 2015.

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