As the Obama administration strives to get people enrolled in Affordable Care Act health plans, a new report from the Robert Wood Johnson Foundation (RWJF) shows that it's also difficult to reach uninsured individuals outside of the standard open enrollment period.
The special enrollment periods (SEPs) allow the 33.5 million Americans each year who experience a qualifying life event that ends their health coverage to enroll in ACA marketplace plans, the report states. Yet fewer than 15 percent of the uninsured who qualify for SEPs use them to enroll in ACA plans.
Within the overall number who qualify for SEPs, 12.9 million people each year would otherwise end up uninsured at the end of the year, the report estimates. Another 20.6 million could use SEPs to avoid temporary gaps in coverage--most of them while switching from one job to another.
The most frequent cause of SEP eligibility is a job loss that ends an individual's employer-sponsored insurance, the report notes. The second most common reason is when an individual's increased income makes him or her ineligible for Medicaid coverage. Other reasons include moving between counties or states, gaining citizenship, adding a child to the family, divorcing or separating from a spouse, or turning 26 and losing parental employer-sponsored coverage.
To increase the share of individuals who take advantage of their SEP eligibility, the report recommends that ACA marketplaces partner with state workforce programs that counsel the unemployed as well as link companies conducting layoffs with insurance brokers, navigators or other assistance.
A previous report from RWJF offered other outreach suggestions for insurers, such as partnering with bridal and maternity stores to reach customers who are about to get married or have a child; or using social media to reach potential customers who are about to turn 26 or who own a small business and need to know how changes to income affect insurance status.
Some Democratic lawmakers, meanwhile, suggested earlier this year that the government should offer newly pregnant women a special enrollment period to sign up for coverage.
To learn more:
- access the report
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