A study released online today in Health Affairs found there is a large number of people who are potentially eligible for special enrollment periods as part of federal and state Marketplace health insurance exchanges, and the majority are uninsured.
The study was led by Lacey Hartman, a senior research fellow at the State Health Access Data Assistance Center (SHADAC) in the School of Public Health at the University of Minnesota.
The authors estimated the number of people who may be eligible for special enrollment periods, which are times outside of regular open enrollment during which people are able to enroll or change their health insurance plans offered through the federal and state-based Marketplaces. The authors found that an estimated 8.4 million people either were uninsured or had non-group coverage at the end of the study period and were likely to become eligible for a special enrollment period because they lost minimum essential coverage, got married, or became parents of a newborn child.
“Our findings also raise a concern related to low income people living in states that did not elect to expand Medicaid,” said Hartman. “We estimate that during our study period, 1.9 million people experienced income shifts outside of the open enrollment period that would make them eligible for Marketplace coverage because their incomes increased above 100 percent of poverty, but they were not eligible to enroll until the next open enrollment period.”
The authors note that, in contrast, people in states that have expanded Medicaid would be eligible for a special enrollment period in this situation because they would have most likely become ineligible for Medicaid and experienced a loss of minimum essential coverage.
“This adds to the burden for low-income individuals in non-expansion states because even once their income increases to a level that would make them eligible to receive subsidies, they have to wait for the next open enrollment period to access coverage,” said Hartman.
Overall, the authors’ findings suggest that there should be ongoing outreach efforts outside of open enrollment periods to help expand access to health care coverage. “We think that the findings should be helpful for policymakers and Marketplace officials as they structure long term plans for outreach and enrollment,” said Hartman.
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