Whether you want to keep your current plan or are looking for a new one, it’s important to log in and update any income or household changes so you get the right savings. You may also discover new plans that better fit your needs.
Don’t miss out – make sure you’re covered today.
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To start your new 2024 Marketplace coverage, pay the first premium. This is the amount you pay every month to the health insurance company to keep your coverage.
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How to pay your monthly premium to start your coverage
Follow your insurance company’s instructions on how to pay.
Pay online. You might be able to pay your first premium through your Marketplace account or through your insurance company.
If you can’t pay online, your insurance company should tell you how to pay your premium. If they didn’t, reach out to them.
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Act now — don’t miss the January 16 deadline to apply for, re-enroll in, or change 2024 health insurance. This holiday season, give yourself the peace of mind that comes with taking care of your health.
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Important deadlines to know
January 16, 2024: Deadline to apply for and enroll in 2024 coverage.
February 1, 2024: Coverage starts.
Apply & enroll now
New to HealthCare.gov? Create an account to fill out an application for the first time.
If you miss the deadline, you may have to wait until next year to get coverage. You can only enroll in or change your health plan for 2024 after January 16 if you qualify for a Special Enrollment Period.
Get help now if you have questions or need help applying.
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Time is running out. The December 15 deadline to apply, re-enroll, or make changes for Marketplace coverage that starts January 1 is approaching fast. Act now to avoid any gaps in coverage.
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Take charge of your health & apply today
Acting now means getting the coverage you need for you and your family that starts January 1.
If you’re new to HealthCare.gov: Create an account and complete an application.
If you have 2023 Marketplace coverage: Log in to your account to update your application, compare plans, and change or renew your plan for next year.
Even if you want to keep your same plan for next year, keep in mind that:
Certain income and household changes can impact the savings you qualify for. Review and update your application to make sure you choose the best plan for next year.
Your health care needs and budget may have changed since you last applied. There might be other plans available that better fit your needs. Explore all plan options so you make the most informed decision.
https://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-12-06 19:00:002023-12-07 14:05:13Don’t delay: Sign up by Dec 15 for coverage that starts Jan 1!
December 15 is the last day to get 2024 coverage that starts January 1. You only have 2 weeks left to visit HealthCare.gov and apply for, renew, or change your Marketplace plan.
Have 2023 coverage & happy with your current plan?
Great! You’ll still want to log into your account and update any expected income or household changes. This makes sure you get the right amount of savings. There may also be new plans that better fit your needs.
Applying for Marketplace coverage for the first time?
Make sure your insurance starts January 1. Visit HealthCare.gov today and beat the December 15 deadline.
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Returning user? Welcome back! Log in to update your application, compare plans, and change or renew for 2024. That way you’ll know your savings are correct and that your plan meets your needs and budget.
Need help applying or have questions? Get help now.
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Before you apply, check out 2024 coverage options in the Marketplace and get an idea if you qualify for savings. Answer a few quick questions to preview plans and prices before enrolling or renewing coverage for 2024 — you don’t even have to log in!
Enroll by December 15 for coverage that starts January 1.
How to save on a 2024 Marketplace plan:
Find Marketplace premiums or see if you may qualify for Medicaid or Children’s Health Insurance Program (CHIP) coverage. Enter:
Your state
The number of people in your household (even if they don’t need health coverage)
Open Enrollment for 2024 health insurance is officially here! From now until January 15, 2024, you can apply for new health coverage or make changes to your existing plan for next year.
Mark your calendar. If you enroll by December 15, your coverage will start on January 1.
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Apply & enroll at HealthCare.gov
While there are many ways to apply and enroll, filling out an application online is usually faster and easier. Here’s how:
If you’re applying for Marketplace insurance for the first time, create an account to get started.
If you’ve been here before, log in to start or update an application.
Medicaid disenrollments resumed several months ago (in April, May, June, or July, depending on the state), and the process is proceeding mostly as expected, with millions already disenrolled. But it’s also had some unexpected problems.
Here’s a look at disenrollments thus far – and a look at who’s been losing Medicaid coverage, and how some who’ve been disenrolled are taking steps to replace their lost coverage.
How many people have been disenrolled from Medicaid?
As of October 19, more than 9 million people had been disenrolled from Medicaid1 as a result of states resuming disenrollments after the pandemic-era federal continuous coverage requirement ended in the spring of 2023.
Eligibility redeterminations – also known as renewals — must be conducted for all Medicaid enrollees during a year-long “unwinding” period. And the disenrollments were not unexpected; HHS had projected that approximately 15 million people would be disenrolled from Medicaid during the unwinding of the pandemic-era continuous coverage rules.2
States had the option to prioritize eligibility redeterminations for enrollees they believed were most likely to no longer be eligible,3 so it’s not surprising that there was a fairly high rate of disenrollments in some states in the early months of the unwinding process. For example, by September (last month), Idaho had already completed eligibility redeterminations for everyone whose eligibility had been pending during the pandemic, and is now back to their normal annual eligibility redeterminations.4
Most disenrollments due to procedural reasons
What may be surprising is that nearly three-quarters of the disenrollments have been for procedural reasons,5 meaning that a state was unable to determine whether someone who had Medicaid coverage was still eligible. This problem can happen because a Medicaid office doesn’t have a beneficiary’s current contact information.
In some cases, a beneficiary received a renewal packet but hasn’t submitted the information the state needs to process the renewal. This could be because the person knows they’re no longer eligible and may have already enrolled in other coverage (such as a plan offered by a new employer). But in other cases, the beneficiary might not understand what’s required in order to complete the renewal, or may have simply fallen behind on dealing with paperwork.
CMS pauses procedural enrollments in 29 states and DC
In late August 2023, the Centers for Medicare and Medicaid Services (CMS) addressed the fact that numerous states had problematic renewal protocols involving households where some members were eligible for ex parte (automatic) renewals and others were not.6 In many states, renewal paperwork was being sent to the household, and if it wasn’t completed, the entire household was being disenrolled, including household members (often children) who were eligible for ex parte renewal.
Twenty-nine states and the District of Columbia have had to pause procedural disenrollments7 until they can confirm that individuals who are eligible for Medicaid or CHIP (Children’s Health Insurance Program) are not being disenrolled due to eligibility redeterminations being conducted at the household (rather than individual) level. And CMS directed states to reinstate coverage for nearly 500,000 people – many of whom are children – whose coverage had been incorrectly terminated due to this issue.8
CMS had previously directed some states to pause procedural disenrollments while problems with their eligibility redetermination processes were addressed. As of June 2023, some or all procedural disenrollments had been paused in DC and 16 states.9
A pause on procedural disenrollments does not prevent a state from continuing to process renewals and disenroll people who no longer meet the eligibility guidelines. It just prevents states from disenrolling people when they don’t have enough information to determine whether the person is still eligible.
And states can adjust their approach to processing Medicaid redeterminations based on state-specific circumstances. For example, Hawaii opted to pause all Medicaid disenrollments through the end of 202310 due to the wildfires in Maui, and will wait until June 2024 to resume eligibility redeterminations for West Maui residents.11
How many people have transitioned from Medicaid to Marketplace coverage?
People who are no longer eligible for Medicaid can switch to other coverage, typically either from an employer, Medicare, or the Marketplace. (Eligibility for each type of coverage depends on the person’s specific circumstances.)
In September 2023, CMS published data on Marketplace enrollments among people who had recently been enrolled in Medicaid.12 As of June 2023:
More than 291,000 former Medicaid enrollees had selected Marketplace qualified health plans (QHPs) through HealthCare.gov.13
More than 63,000 people had selected QHPs through state-run exchanges.14
In addition, nearly 56,000 people had transitioned to Basic Health Program (BHP) coverage in New York and Minnesota.15
So, based on CMS’ recent reports, more than 410,000 former Medicaid enrollees had transitioned to Marketplace coverage – QHP or BHP coverage – by June 2023.
In the state-run exchanges, enrollment included nearly 7,600 people for whom a QHP had been automatically selected.14 Only four states (California, Maryland, Massachusetts, and Rhode Island) have implemented auto-enrollment protocols for at least some people whose Medicaid is terminated during the unwinding process. In the rest of the country, a person’s data may be transferred to the Marketplace, but they must actively select a plan in order to enroll in a QHP.16
Subsidies for Medicaid beneficiaries transitioning to coverage on the Marketplace
Last year, CMS had estimated that 2.7 million people losing Medicaid during the unwinding period would be eligible for advance premium tax credits (APTC) to offset the cost of Marketplace coverage.2 As of June 2023, a total of about 583,000 former Medicaid enrollees had been deemed eligible for APTC (337,230 in states that use HealthCare.gov17 and 245,879 in states that run their own exchanges.18)
APTC eligibility depends on income but also on whether the person has an offer of affordable coverage from an employer. People who lose Medicaid but are eligible to enroll in an employer’s plan are generally not eligible for financial assistance in the Marketplace.
Special enrollment in the Marketplace for those disenrolled from Medicaid
It’s important to note that HealthCare.gov has an ongoing special enrollment period, through July 2024, for people who lose Medicaid during the unwinding process. So a person who lost Medicaid early in the unwinding process still has a lengthy window to enroll in a Marketplace plan if that’s their preference.
States that run their own exchanges can choose to offer extended special enrollment periods for people who lose Medicaid, or they can use the normal special enrollment period rules that allow a person up to 60 days to select a new plan after losing Medicaid.
What should current enrollees expect as Medicaid redetermination continues?
While the number of disenrollments is over 9 million, it’s important to note that the redetermination process is still ongoing. Current enrollees should keep an eye out for communications from their state’s Medicaid office, especially if their coverage hasn’t been renewed recently.
In most states, the eligibility redetermination process begins two or three months before an enrollee’s renewal date. Federal rules require states to give most Medicaid enrollees at least 30 days to return their renewal packets, but states often allow 45 days or more. (For Medicaid enrollees who are 65 or older, or who are eligible due to disability or blindness, the state must provide “a reasonable period of time.”)19
If the state is able to renew an individual’s coverage automatically, the beneficiary will simply receive a notification letting them know that their coverage has been renewed. But if not, the state will let them know what information they have to provide in order to renew coverage, along with a deadline at least 30 days out.
If a person does not submit the necessary documentation by the deadline, coverage can be terminated. However, if a beneficiary submits the renewal information no more than 90 days after the coverage was terminated, states are required to determine eligibility without requiring the person to submit a new application, and reinstate coverage if the person is eligible.20
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Open Enrollment for 2024 coverage starts November 1! Get a jump start by previewing 2024 plans with personalized price estimates based on your estimated income and household size.
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Preview personalized 2024 plans & prices
Previewing plans before Open Enrollment starts can help you compare different options, so you’re ready to choose a plan starting November 1.
Answer some quick questions about your expected 2024 household income and household members for health plans and estimated prices.
These are just estimates. When you log in to submit your application during Open Enrollment, you’ll discover exact prices based on your income and household information.
So, what are you waiting for? Preview 2024 plans and price estimates now to get a head start on Open Enrollment. Then, come back during Open Enrollment from November 1-January 15 for exact prices, to compare plans, and enroll.
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You can enroll in a Marketplace health plan for 2024 starting November 1, but don’t wait to get ready. Start preparing now to make enrollment faster and easier.
Use this checklist (PDF, 189 KB)to get what you need before you start your application. This way you’ll be ready when the Marketplace asks for basic information about you and your household.
The Affordable Care Act (ACA) has faced numerous legal challenges, but has been upheld three times by the Supreme Court. Over the years, the headlines surrounding the possibility of the ACA (aka Obamacare) being overturned have often focused on people with pre-existing conditions who buy their own health insurance. (This is certainly a valid concern, as those individuals would undoubtedly be worse off without the ACA.)
But the impact of the ACA goes well beyond securing access to healthcare for people with pre-existing conditions. Who are these Americans, whose lives are better off, thanks to the ACA? See if you can find yourself – or your loved ones – in this list:
More than 14 million Americans (91% of all Marketplace/exchange enrollees) who are receiving premium subsidies in the exchanges that make their coverage affordable. The average full-price premium is $605/month in 2023, but the average subsidy amount ($527/month) covers the majority of the average premium.
People with pre-existing conditions who gain access to an employer-sponsored plan after being uninsured for 63+ days. HIPAA guaranteed that they could enroll in the employer-sponsored plan, but there were waiting periods for pre-existing conditions. The ACA eliminated those waiting periods.
People who gain access to an employer’s plan and have a waiting period of no more than 90 days before their coverage takes effect. Pre-ACA, employers could determine their own waiting periods, which were sometimes longer than three months.
Full-time (30+ hours/week) workers at large businesses who are offered real health insurance instead of “mini-med” plans, thanks to the employer mandate. (Employers can choose not to comply, but they face a penalty in that case.)
People with serious conditions often exhausted their coverage under pre-ACA plan because of annual or lifetime benefits caps.
People with serious medical conditions who would otherwise have exhausted their coverage in the private market, including employer-sponsored plans. Pre-ACA, annual and lifetime benefit caps were the norm. And it could be shockingly easy to hit those maximums if you had a premature baby or a serious medical condition.
Coal miners with black lung disease, and their survivors. The ACA made benefits under the Black Lung Benefits Act of 1972 available to more people.
Nursing home residents – and people with loved ones living in nursing homes – who benefit from federal funding for background checks on employees who interact with patients.
Women (and their partners) who have access to contraception at no cost – including birth control methods such as IUDs, implants, and tubal ligations that are highly effective but would have prohibitively high up-front costs if they weren’t covered by insurance.
Expectant parents – male and female – who can enroll in a health plan in the individual market. (Pre-ACA, expectant parents’ applications were rejected in nearly every state.)
People who buy their own health insurance and would like to have a child. Pre-ACA, individual health insurance rarely covered maternity care.
Breastfeeding mothers who have access to breast pumps and breastfeeding counseling as part of their insurance benefits. The ACA also guarantees that breastfeeding mothers who work for large employers have access to adequate breaks and a private, non-bathroom area for pumping milk.
Anyone who is better off in a world where people in need of mental health care can access it – because their health insurance covers it and they aren’t rejected altogether when they apply for a new health plan.
People with substance abuse disorders who can obtain treatment that would be unaffordable without health insurance coverage.
The 21 million people who have gained access to Medicaid thanks to the ACA’s expansion of coverage to low-income adults.
Low-income families and individuals who no longer have to meet asset tests in order to qualify for Medicaid or CHIP, with eligibility now based on the ACA’s modified adjusted gross income instead (some populations, including the elderly and disabled, are still subject to asset tests for Medicaid eligibility).
Individuals and employers whose insurers are required to spend at least 80% or 85% of premiums on members’ medical claims and quality improvements.
People age 65 and older, including recent immigrants, who are able to enroll in ACA-compliant health plans if they’re not eligible for premium-free Medicare (pre-ACA, individual market insurers generally would not enroll people over age 64).
Older people (including those age 65+ who aren’t eligible for premium-free Medicare), whose premiums are no more than three times as much as the premiums for a 21-year-old.
People who buy their own health insurance and no longer have to worry that the policy could get rescinded because they forgot to mention something on the application. (This was usually due to an omission in the medical history section, and those questions are no longer asked – thanks, also, to the ACA.)
Everyone who benefits from the ACA’s risk adjustment program, which levels the playing field and helps to prevent plan designs that would be unappealing to individuals and groups with high-cost medical conditions.
Native Americans and Alaska Natives, who can enroll year-round in plans sold through the exchanges, and who are eligible for plans with zero cost-sharing if their income doesn’t exceed 300% of the poverty level. (That’s $90,000 for a family of four enrolling in 2024 coverage.)
Native Americans and Alaska Natives who receive care via Indian Health Services – as the ACA permanently reauthorized the Indian Health Care Improvement Act.
People who are protected from discrimination in healthcare based on race, national origin, sex, age, or disability, thanks to Section 1557 of the ACA. (The details of how these protections work are determined by HHS, so there have been some changes over time. HHS initiallyissued rulemaking in 2016, but it wasrolled back in 2020. However, HHS proposed new rules in 2022 that would largely revert to the stronger anti-discrimination protections that were implemented in 2016.)
People who shop for coverage in the health insurance exchange and find the new star rating system for health plans to be helpful during the plan selection process.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
https://www.maddoxinsurememphis.com/wp-content/uploads/2023/09/preexisting-condition-cancer-aca.jpg6281200wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-09-21 01:12:142023-09-22 15:05:1650 populations whose lives are better thanks to the ACA
It’s important to get the flu shot to protect you and your family from this potentially serious disease. The Centers for Disease Control and Prevention recommends that everyone 6 months and older get a flu shot by the end of October.
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3 reasons to get the flu shot this year:
It’s free. With Marketplace health insurance, immunizations are a covered preventive care benefit. Your flu shot is free from a provider in your plan’s network.
It’s easy. You can get the flu shot at many locations, like pharmacies and grocery stores.
It helps protect you and others. A flu shot can lower your chance of getting sick and spreading the flu to others.
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Open Enrollment for 2024 Marketplace health plans starts November 1. Don’t lose out on valuable health insurance information and deadline reminders this fall by connecting with the Marketplace today.
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3 quick & easy ways to connect
Take a few minutes right now to stay in the loop. This way, you’ll get regular reminders and updates as Open Enrollment gets closer.
Sign up for email or text updates.Visit HealthCare.gov, and click “Sign up” under “Get important news & updates.”
You can also get help in your community.Enter your ZIP code for a list of people and groups near you that are trained to help you apply. Some even offer help in languages other than English.
Explore HealthCare.gov to find out dates and deadlines, learn why having health insurance is important, and get enrollment tips. Get started with a quick guide.
https://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-09-06 20:00:002023-09-07 15:04:03Don’t miss out: Connect with the Marketplace in 3 simple ways
https://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-09-02 10:00:002023-09-02 15:05:00Farmers Insurance® Deploys to Help Customers Impacted by Hurricane Idalia; Establishes Relief Sites in Florida and Georgia
https://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-08-28 13:40:002023-08-28 15:14:13Farmers® Announces New Strategy and Organizational Structure for Long-term Sustainable Profitability
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Since 2018, federal rules have made it possible for consumers in many states to buy short-term, limited-duration insurance (STLDI) and keep that coverage for as long as three years, including renewals and extensions. (States can set their own more stringent rules, which is why these rules don’t apply nationwide.) But a rule proposed by the Biden administration in July 2023 would significantly limit the length of STLDI plans.
If finalized, the rule would limit the initial term of STLDI policies to no longer than three months. Though the rule would allow renewal of a policy, the total duration of a plan would be limited to four months, and a buyer would not be allowed to purchase another short-term plan from the same insurer within 12 months of their initial policy effective date.
The agencies publishing the rule noted that these changes are designed to ensure that short-term coverage is used to fill a temporary gap between two comprehensive policies, rather than serving as a long-term coverage solution. The rule is also intended to reduce the number of people who inadvertently purchase short-term coverage when trying to buy comprehensive coverage.
In introducing the proposed rule, President Biden said his administration is “cracking down” on limited-duration insurance being sold to individuals who often don’t understand the coverage and then are surprised when they get hit with large medical bills.
The proposed change would roll back a 2018 rule that expanded the availability of short-term, limited-duration plans, allowing them to last for up to three years if the coverage is renewable.
The Centers for Medicare & Medicaid Services is accepting public comments on the proposed rule until September 11, 2023. Rulemaking is a multi-month process, so any rule change likely won’t be finalized until late 2023.
If approved, the rules would not apply to new short-term policies until 75 days after the rule is finalized. Policies issued before that date would not have to comply with the new rules.
For now, consumers in many states can continue enrolling in longer-duration short-term plans. We say “many states” because although the 2018 rule permits states to allow the sale of longer-duration plans, nearly half of the states have adopted stricter limits on STLDI duration. (See details below for each state.)
Some states have banned the sale of short-term plans outright while other states have adopted regulations that have caused insurers to stop selling the plans.
Limit short-term plans to initial terms of up to 364 days.
Allow short-term plans to be renewed as long as the total duration of the plan doesn’t exceed 36 months.
Require short-term plan information to include a disclosure to help people understand how short-term plans differ from individual health insurance.
Under the Biden administration’s proposed rule:
New short-term policies would be limited to initial terms of no more than three months.
Carriers would be able to offer renewable policies, but the total duration – including renewals – could not exceed four months. The proposed rule notes that the three-month window is designed to align with the maximum waiting period that a new employee can be subject to before being eligible for an employer-sponsored health plan.
A consumer would not be allowed to purchase an additional short-term policy from the same insurer within 12 months of the effective date of the first policy.
The required disclosure notice would be updated to clarify that federal financial assistance is not available with short-term policies, and that surprise balance billing protections do not apply to these policies.
State regulatory flexibility regarding short-term plans
As noted above, HHS made it clear in the 2018 regulations that although the federal rules expanded the limits on short-term plan duration, states may continue to implement more restrictive rules, just as they did prior to 2017. (States cannot implement rules that are more lenient than the federal regulations.)
States are taking varying approaches on short-term plans, with some clearly wanting to expand access, while others prefer to restrict or eliminate short-term plans in an effort to protect their ACA-compliant markets.
In Washington, the sale of short-term health plans was discontinued in mid-2022 and no insurers offer short-term health plans in Washington as of 2023. New Hampshire and Minnesota also had no insurers offering short-term health plans by mid-2023.
In addition, several states had already capped the duration of short-term plans at three or six months, even before the Obama administration took action to limit short-term plans. Other states have subsequently implemented three- or six-month caps on short-term plans.
Ultimately, there are more states with their own restrictions on short-term plans than there are states that are defaulting to the federal rules. Use this map to see how states restrict short-term plans.
If the Biden administration’s proposed rules are finalized, states will no longer have the option to allow short-term policies to have initial terms of more than three months, or total durations of more than four months. Policies with longer terms would not be considered short-term plans and would have to comply with the ACA’s rules for individual-market coverage.
Current state limits on duration of short-term plans
States allowing short-term plans to have duration up to six months
Colorado – Six-month initial durations are allowed, but insurers stopped offering short-term plans as of 2019.
A handful of states allow short-term plans to have initial terms in line with the new federal rules (364 days), but place more restrictive limits on renewals and total plan duration:
Idaho – “Enhanced” short-term plans are guaranteed renewable for total duration of three years. State limits initial duration of non-enhanced short-term plans to six months with no renewals.
South Carolina – (11-month maximum initial term, and 33-month maximum duration.)
Wisconsin – (Total duration limited to 18 months.)
In 14 states and the District of Columbia, no short-term plans are available for purchase. In some cases, state regulations ban sale of the plans outright. In others, state regulations make it unappealing for insurers to offer short-term plans.
California – State law prohibits the sale of short-term plans.
Colorado – As noted, plans are technically allowed with six-month initial durations, but insurers have stopped offering short-term plans.
Massachusetts – Health plans are required to be guaranteed-issue, so short-term policies are not available in the state
New Mexico – State regulations limit the plans to three months and prohibit renewals, but no insurers were offering plans as of mid-2019.
Rhode Island – STLDI is not banned, but state rules are strict enough that no insurers offer these policies
Vermont – There are no short-term plans available in Vermont, but legislation was also enacted in 2018 to limit short-term plans to three months and prohibit renewals, in case any plans are approved in the future.
Washington – Plans are allowed for up to three months, but no insurers offer them.
You can use the map on this page to see more details about short-term health insurance rules and availability in each state.
The path to current short-term federal rules
Under regulation changes that HHS finalized in 2018 – and in effect since October of 2018 – the initial duration of short-term plans was lengthened to 364 days with an option to renew a plan for coverage up to a total of three years. This 2018 rule reversed regulations – put in place by the Obama administration – that had limited short-term plan durations to 90 days and did not allow renewal of policies.
The 2018 rule also established that a plan is considered “short-term” as long as it has an initial term of less than a year (no more than 364 days).
But the 2018 rule also allows short-term plans to offer enrollees the option to renew their plans without additional medical underwriting and use renewal to keep the same plan in force for up to 36 months.
Under the Trump administration, HHS justified this by noting that the coverage has long been called “short-term limited duration” health coverage, and pointing out that “short-term” and “limited duration” must mean different things, otherwise the phrases would be redundant.
So HHS said that “short-term” refers to the initial term, which must be under 12 months. But they allowed the “limited duration” part to mean up to 36 months in total, under the same plan.
It’s important to note that HHS may have expected this to be challenged in court, as they included a severability clause for the part about 36-month total duration: If a court were to strike down that provision, the rest of the rule would remain in place. (A lawsuit was filed over the legality of the new short-term insurance rule in September 2018, but that case ended with a ruling in favor of the Trump administration.)
In the 2018 rule, HHS noted that there is nothing in federal statute that would prevent a person from enrolling in a new short-term plan after the 36 months (or purchasing an option from the initial insurer that will allow them to buy a new plan at a later date, with the new plan allowed to start after the full 36-month duration of the prior plan).
So technically, federal rules allow people to string together multiple “short-term” plans indefinitely. But as noted above, there are quite a few states with much stronger short-term plan regulations, and some states implemented restrictions on short-term plans specifically in response to the new federal rules.
The disclosure notice required in the 2018 rule was intended to inform consumers of several aspects of short-term coverage: That the plans are not required to comply with the ACA, may not cover certain medical costs, and may impose annual/lifetime benefit limits. The disclosure also notes that the termination of a short-term plan does not trigger a special enrollment period in the individual market (although it does for group health plans).
Enrollees who develop health conditions while covered under a short-term plan – and may be subject to pre-existing condition exclusions under a new short-term plan – might find themselves without short-term coverage and having to wait until the next open enrollment period to sign up for Marketplace coverage.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
https://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsurememphis.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2023-08-22 03:00:152023-12-12 14:01:40Proposed rule would limit duration of coverage under short-term health plans to 4 months
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Over 9 million Medicaid beneficiaries disenrolled as redeterminations continue
In this article
Medicaid disenrollments resumed several months ago (in April, May, June, or July, depending on the state), and the process is proceeding mostly as expected, with millions already disenrolled. But it’s also had some unexpected problems.
Here’s a look at disenrollments thus far – and a look at who’s been losing Medicaid coverage, and how some who’ve been disenrolled are taking steps to replace their lost coverage.
How many people have been disenrolled from Medicaid?
As of October 19, more than 9 million people had been disenrolled from Medicaid1 as a result of states resuming disenrollments after the pandemic-era federal continuous coverage requirement ended in the spring of 2023.
Eligibility redeterminations – also known as renewals — must be conducted for all Medicaid enrollees during a year-long “unwinding” period. And the disenrollments were not unexpected; HHS had projected that approximately 15 million people would be disenrolled from Medicaid during the unwinding of the pandemic-era continuous coverage rules.2
States had the option to prioritize eligibility redeterminations for enrollees they believed were most likely to no longer be eligible,3 so it’s not surprising that there was a fairly high rate of disenrollments in some states in the early months of the unwinding process. For example, by September (last month), Idaho had already completed eligibility redeterminations for everyone whose eligibility had been pending during the pandemic, and is now back to their normal annual eligibility redeterminations.4
Most disenrollments due to procedural reasons
What may be surprising is that nearly three-quarters of the disenrollments have been for procedural reasons,5 meaning that a state was unable to determine whether someone who had Medicaid coverage was still eligible. This problem can happen because a Medicaid office doesn’t have a beneficiary’s current contact information.
In some cases, a beneficiary received a renewal packet but hasn’t submitted the information the state needs to process the renewal. This could be because the person knows they’re no longer eligible and may have already enrolled in other coverage (such as a plan offered by a new employer). But in other cases, the beneficiary might not understand what’s required in order to complete the renewal, or may have simply fallen behind on dealing with paperwork.
CMS pauses procedural enrollments in 29 states and DC
In late August 2023, the Centers for Medicare and Medicaid Services (CMS) addressed the fact that numerous states had problematic renewal protocols involving households where some members were eligible for ex parte (automatic) renewals and others were not.6 In many states, renewal paperwork was being sent to the household, and if it wasn’t completed, the entire household was being disenrolled, including household members (often children) who were eligible for ex parte renewal.
Twenty-nine states and the District of Columbia have had to pause procedural disenrollments7 until they can confirm that individuals who are eligible for Medicaid or CHIP (Children’s Health Insurance Program) are not being disenrolled due to eligibility redeterminations being conducted at the household (rather than individual) level. And CMS directed states to reinstate coverage for nearly 500,000 people – many of whom are children – whose coverage had been incorrectly terminated due to this issue.8
CMS had previously directed some states to pause procedural disenrollments while problems with their eligibility redetermination processes were addressed. As of June 2023, some or all procedural disenrollments had been paused in DC and 16 states.9
A pause on procedural disenrollments does not prevent a state from continuing to process renewals and disenroll people who no longer meet the eligibility guidelines. It just prevents states from disenrolling people when they don’t have enough information to determine whether the person is still eligible.
And states can adjust their approach to processing Medicaid redeterminations based on state-specific circumstances. For example, Hawaii opted to pause all Medicaid disenrollments through the end of 202310 due to the wildfires in Maui, and will wait until June 2024 to resume eligibility redeterminations for West Maui residents.11
How many people have transitioned from Medicaid to Marketplace coverage?
People who are no longer eligible for Medicaid can switch to other coverage, typically either from an employer, Medicare, or the Marketplace. (Eligibility for each type of coverage depends on the person’s specific circumstances.)
In September 2023, CMS published data on Marketplace enrollments among people who had recently been enrolled in Medicaid.12 As of June 2023:
So, based on CMS’ recent reports, more than 410,000 former Medicaid enrollees had transitioned to Marketplace coverage – QHP or BHP coverage – by June 2023.
In the state-run exchanges, enrollment included nearly 7,600 people for whom a QHP had been automatically selected.14 Only four states (California, Maryland, Massachusetts, and Rhode Island) have implemented auto-enrollment protocols for at least some people whose Medicaid is terminated during the unwinding process. In the rest of the country, a person’s data may be transferred to the Marketplace, but they must actively select a plan in order to enroll in a QHP.16
Subsidies for Medicaid beneficiaries transitioning to coverage on the Marketplace
Last year, CMS had estimated that 2.7 million people losing Medicaid during the unwinding period would be eligible for advance premium tax credits (APTC) to offset the cost of Marketplace coverage.2 As of June 2023, a total of about 583,000 former Medicaid enrollees had been deemed eligible for APTC (337,230 in states that use HealthCare.gov17 and 245,879 in states that run their own exchanges.18)
APTC eligibility depends on income but also on whether the person has an offer of affordable coverage from an employer. People who lose Medicaid but are eligible to enroll in an employer’s plan are generally not eligible for financial assistance in the Marketplace.
Special enrollment in the Marketplace for those disenrolled from Medicaid
It’s important to note that HealthCare.gov has an ongoing special enrollment period, through July 2024, for people who lose Medicaid during the unwinding process. So a person who lost Medicaid early in the unwinding process still has a lengthy window to enroll in a Marketplace plan if that’s their preference.
States that run their own exchanges can choose to offer extended special enrollment periods for people who lose Medicaid, or they can use the normal special enrollment period rules that allow a person up to 60 days to select a new plan after losing Medicaid.
What should current enrollees expect as Medicaid redetermination continues?
While the number of disenrollments is over 9 million, it’s important to note that the redetermination process is still ongoing. Current enrollees should keep an eye out for communications from their state’s Medicaid office, especially if their coverage hasn’t been renewed recently.
In most states, the eligibility redetermination process begins two or three months before an enrollee’s renewal date. Federal rules require states to give most Medicaid enrollees at least 30 days to return their renewal packets, but states often allow 45 days or more. (For Medicaid enrollees who are 65 or older, or who are eligible due to disability or blindness, the state must provide “a reasonable period of time.”)19
If the state is able to renew an individual’s coverage automatically, the beneficiary will simply receive a notification letting them know that their coverage has been renewed. But if not, the state will let them know what information they have to provide in order to renew coverage, along with a deadline at least 30 days out.
If a person does not submit the necessary documentation by the deadline, coverage can be terminated. However, if a beneficiary submits the renewal information no more than 90 days after the coverage was terminated, states are required to determine eligibility without requiring the person to submit a new application, and reinstate coverage if the person is eligible.20
Read our overview of Medicaid redetermination to learn more about coverage replacement options for people who are disenrolled from Medicaid. The overview also links to pages devoted to each state’s Medicaid program, with details about how the unwinding process is being handled.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Footnotes
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50 populations whose lives are better thanks to the ACA
The Affordable Care Act (ACA) has faced numerous legal challenges, but has been upheld three times by the Supreme Court. Over the years, the headlines surrounding the possibility of the ACA (aka Obamacare) being overturned have often focused on people with pre-existing conditions who buy their own health insurance. (This is certainly a valid concern, as those individuals would undoubtedly be worse off without the ACA.)
But the impact of the ACA goes well beyond securing access to healthcare for people with pre-existing conditions. Who are these Americans, whose lives are better off, thanks to the ACA? See if you can find yourself – or your loved ones – in this list:
People with serious conditions often exhausted their coverage under pre-ACA plan because of annual or lifetime benefits caps.
People with serious medical conditions who would otherwise have exhausted their coverage in the private market, including employer-sponsored plans. Pre-ACA, annual and lifetime benefit caps were the norm. And it could be shockingly easy to hit those maximums if you had a premature baby or a serious medical condition.
ACA’s marketplace plans must cover a list of vaccinations for children from birth to age 18.
Children who have access to free vaccines and well-child care.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Get your flu shot this fall at no cost
It’s important to get the flu shot to protect you and your family from this potentially serious disease. The Centers for Disease Control and Prevention recommends that everyone 6 months and older get a flu shot by the end of October.
3 reasons to get the flu shot this year:
Get more information on protecting yourself from the flu.
Don’t miss out: Connect with the Marketplace in 3 simple ways
Open Enrollment for 2024 Marketplace health plans starts November 1. Don’t lose out on valuable health insurance information and deadline reminders this fall by connecting with the Marketplace today.
3 quick & easy ways to connect
Take a few minutes right now to stay in the loop. This way, you’ll get regular reminders and updates as Open Enrollment gets closer.
Explore HealthCare.gov to find out dates and deadlines, learn why having health insurance is important, and get enrollment tips. Get started with a quick guide.
Farmers Insurance® Deploys to Help Customers Impacted by Hurricane Idalia; Establishes Relief Sites in Florida and Georgia
Farmers Insurance® Ready to Assist Customers Impacted by Hurricane Idalia
Farmers® Announces New Strategy and Organizational Structure for Long-term Sustainable Profitability
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Proposed rule would limit duration of coverage under short-term health plans to 4 months
In this article:
Since 2018, federal rules have made it possible for consumers in many states to buy short-term, limited-duration insurance (STLDI) and keep that coverage for as long as three years, including renewals and extensions. (States can set their own more stringent rules, which is why these rules don’t apply nationwide.) But a rule proposed by the Biden administration in July 2023 would significantly limit the length of STLDI plans.
If finalized, the rule would limit the initial term of STLDI policies to no longer than three months. Though the rule would allow renewal of a policy, the total duration of a plan would be limited to four months, and a buyer would not be allowed to purchase another short-term plan from the same insurer within 12 months of their initial policy effective date.
The agencies publishing the rule noted that these changes are designed to ensure that short-term coverage is used to fill a temporary gap between two comprehensive policies, rather than serving as a long-term coverage solution. The rule is also intended to reduce the number of people who inadvertently purchase short-term coverage when trying to buy comprehensive coverage.
In introducing the proposed rule, President Biden said his administration is “cracking down” on limited-duration insurance being sold to individuals who often don’t understand the coverage and then are surprised when they get hit with large medical bills.
The proposed change would roll back a 2018 rule that expanded the availability of short-term, limited-duration plans, allowing them to last for up to three years if the coverage is renewable.
According to the National Association of Insurance Commissioners, 235,775 people were covered under short-term policies as of 2022. However, the actual number of enrollees is uncertain because insurance carriers are not required to report enrollment data.
What happens next?
The Centers for Medicare & Medicaid Services is accepting public comments on the proposed rule until September 11, 2023. Rulemaking is a multi-month process, so any rule change likely won’t be finalized until late 2023.
If approved, the rules would not apply to new short-term policies until 75 days after the rule is finalized. Policies issued before that date would not have to comply with the new rules.
For now, consumers in many states can continue enrolling in longer-duration short-term plans. We say “many states” because although the 2018 rule permits states to allow the sale of longer-duration plans, nearly half of the states have adopted stricter limits on STLDI duration. (See details below for each state.)
Some states have banned the sale of short-term plans outright while other states have adopted regulations that have caused insurers to stop selling the plans.
The Biden administration’s proposed changes
The proposed rule published in July 2023, would change all three of the rules that the Trump administration put in place. Those 2018 rules:
Under the Biden administration’s proposed rule:
The required disclosure notice would be updated to clarify that federal financial assistance is not available with short-term policies, and that surprise balance billing protections do not apply to these policies.
State regulatory flexibility regarding short-term plans
As noted above, HHS made it clear in the 2018 regulations that although the federal rules expanded the limits on short-term plan duration, states may continue to implement more restrictive rules, just as they did prior to 2017. (States cannot implement rules that are more lenient than the federal regulations.)
States are taking varying approaches on short-term plans, with some clearly wanting to expand access, while others prefer to restrict or eliminate short-term plans in an effort to protect their ACA-compliant markets.
In a few states – New York, New Jersey, Massachusetts, Rhode Island, and Vermont – short-term plans weren’t sold at all as of 2018. And by 2020, five additional states – California, Colorado, New Mexico, Maine, and Hawaii – and Washington, DC also had no insurers offering short-term plans.
In Washington, the sale of short-term health plans was discontinued in mid-2022 and no insurers offer short-term health plans in Washington as of 2023. New Hampshire and Minnesota also had no insurers offering short-term health plans by mid-2023.
In addition, several states had already capped the duration of short-term plans at three or six months, even before the Obama administration took action to limit short-term plans. Other states have subsequently implemented three- or six-month caps on short-term plans.
Ultimately, there are more states with their own restrictions on short-term plans than there are states that are defaulting to the federal rules. Use this map to see how states restrict short-term plans.
If the Biden administration’s proposed rules are finalized, states will no longer have the option to allow short-term policies to have initial terms of more than three months, or total durations of more than four months. Policies with longer terms would not be considered short-term plans and would have to comply with the ACA’s rules for individual-market coverage.
Current state limits on duration of short-term plans
States allowing short-term plans to have duration up to six months
States (and the District of Columbia) allowing short-term plans to have duration up to three months
A handful of states allow short-term plans to have initial terms in line with the new federal rules (364 days), but place more restrictive limits on renewals and total plan duration:
In 14 states and the District of Columbia, no short-term plans are available for purchase. In some cases, state regulations ban sale of the plans outright. In others, state regulations make it unappealing for insurers to offer short-term plans.
You can use the map on this page to see more details about short-term health insurance rules and availability in each state.
The path to current short-term federal rules
Under regulation changes that HHS finalized in 2018 – and in effect since October of 2018 – the initial duration of short-term plans was lengthened to 364 days with an option to renew a plan for coverage up to a total of three years. This 2018 rule reversed regulations – put in place by the Obama administration – that had limited short-term plan durations to 90 days and did not allow renewal of policies.
The 2018 rule also established that a plan is considered “short-term” as long as it has an initial term of less than a year (no more than 364 days).
But the 2018 rule also allows short-term plans to offer enrollees the option to renew their plans without additional medical underwriting and use renewal to keep the same plan in force for up to 36 months.
Under the Trump administration, HHS justified this by noting that the coverage has long been called “short-term limited duration” health coverage, and pointing out that “short-term” and “limited duration” must mean different things, otherwise the phrases would be redundant.
So HHS said that “short-term” refers to the initial term, which must be under 12 months. But they allowed the “limited duration” part to mean up to 36 months in total, under the same plan.
It’s important to note that HHS may have expected this to be challenged in court, as they included a severability clause for the part about 36-month total duration: If a court were to strike down that provision, the rest of the rule would remain in place. (A lawsuit was filed over the legality of the new short-term insurance rule in September 2018, but that case ended with a ruling in favor of the Trump administration.)
In the 2018 rule, HHS noted that there is nothing in federal statute that would prevent a person from enrolling in a new short-term plan after the 36 months (or purchasing an option from the initial insurer that will allow them to buy a new plan at a later date, with the new plan allowed to start after the full 36-month duration of the prior plan).
So technically, federal rules allow people to string together multiple “short-term” plans indefinitely. But as noted above, there are quite a few states with much stronger short-term plan regulations, and some states implemented restrictions on short-term plans specifically in response to the new federal rules.
The disclosure notice required in the 2018 rule was intended to inform consumers of several aspects of short-term coverage: That the plans are not required to comply with the ACA, may not cover certain medical costs, and may impose annual/lifetime benefit limits. The disclosure also notes that the termination of a short-term plan does not trigger a special enrollment period in the individual market (although it does for group health plans).
Enrollees who develop health conditions while covered under a short-term plan – and may be subject to pre-existing condition exclusions under a new short-term plan – might find themselves without short-term coverage and having to wait until the next open enrollment period to sign up for Marketplace coverage.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.