Last Friday, the administration appeared to give with one hand what they had taken away with another: they created a brand new special enrollment period (SEP). Just the week prior, in response to concerns from insurers over the number of SEPs, the administration eliminated several and tightened eligibility for another.
This new SEP will certainly be a more significant pathway to coverage outside of open enrollment than the eliminated SEPs had been. It will be available to the estimated 710,000 individuals who received premium tax credits in 2014 but failed to file a corresponding tax return and to reconcile their tax credits. The SEP will extend through March 31, 2016, and only individuals determined ineligible for premium tax credits in 2016 because of their past failure to file and to reconcile their 2014 tax credit will be able to take advantage of it. These individuals must file a 2014 tax return and reconcile their 2014 premium tax credits to qualify for this SEP.
In spite of insurers’ concerns about the number of SEPs, the administration’s approach is consistent with its policy of minimizing gaps in coverage and providing opportunities to enroll when implementing and enforcing first-time provisions of the ACA. This is the first year that the marketplace is disqualifying individuals for financial assistance because of their failure to file and to reconcile their 2014 premium tax credit, so it makes sense that the administration would give them some flexibility if they failed to do so. The majority of premium tax credit recipients are moderate to low-income individuals, and many may not have filed tax returns previously. It is likely that this SEP will be a one-time occurrence as consumers become more familiar with the ACA’s requirements to have health insurance coverage or pay a penalty, and to file and to reconcile premium tax credits annually.