As COVID-19 cases continue to climb, access to health insurance remains critical as consumers continue to need access to health care services, including those to prevent and treat COVID-19. However, prior to the outbreak, 28 million Americans were uninsured, which is projected to increase by over 7.3 million as individuals lose jobs and employer-sponsored health insurance coverage. Leading efforts to increase access to insurance are the nation’s state-based health insurance marketplaces (SBMs).
The mission of the SBMs, which exercise more control over their marketplaces than states that use the federal marketplace, is to provide access to affordable, quality insurance plans to individuals. SBMs, which currently number at 13, have a long history of leveraging state flexibility to take proactive steps to improve consumer experiences, invest in outreach and marketing to draw in the uninsured, and to develop policies to lower their health plans costs.
They also offer a no-wrong door eligibility and enrollment portal for all coverage programs, including private coverage, Medicaid, and the Children’s Health Insurance Program (CHIP). The SBMs have collectively maintained stable enrollment, while, on average, having lower individual market premiums than states that use the federal marketplace (FFM). (For more about SBM successes, read State-based Marketplace Leaders Share their Success and Growth with Federal Leaders.)
SBM Efforts during COVID-19
In light of the COVID-19 pandemic, the SBMs have redoubled efforts to ensure that consumers are aware of and able to access health insurance coverage. Responding to one of the nation’s first reported COVID-19 outbreaks, on March 9, 2020, Washington State’s SBM was the first to offer a special enrollment period (SEP) to enable uninsured individuals to enroll in coverage. Eleven SBMs followed suit, recognizing the public health importance of coverage as a critical step to facilitate access to preventative services such as testing, while also enabling access to treatment without excessive fear of high medical bills.
In addition, all SBMs increased efforts to educate consumers about existing coverage options, including SEPs available to individuals who experience income changes or loss of employer-sponsored job loss. Several developed partnerships with their local departments of unemployment to provide direct outreach to those most effected by economic changes.
Beyond these efforts, SBMs have worked quickly to develop new resources and to enact operational changes. SBMs in California, Colorado, Washington, DC, Maryland, Minnesota, and Nevada launched comprehensive resource pages with links to educational information about COVID-19 and related coverage questions. Washington, DC, for example, included a simple chart to indicate what COVID-19-related services were covered by each of its participating insurance carriers. Meanwhile, SBMs worked with partners and vendors to develop new guidelines and FAQs documents so that outreach and customer service tools such as Navigator programs and call centers could provide robust services even while shifting to socially distanced or modified workplaces.
SBMs are adapting eligibility and enrollment systems to ease enrollment processes and expedite access to coverage. Recognizing the financial and other uncertainties facing millions of Americans who may be experiencing extreme fluctuations in income or circumstance, many SBMs have provided flexibility, where practical, on issues such as providing more time for submission of income verifications normally necessary to determine eligibility. SBMs have also collaborated with insurers to accelerate the start-dates of coverage, eliminating the waiting period usually needed between enrollment through the market and the actual first day of insurance coverage. SBMs have worked closely with their insurers and state insurance departments to encourage or require grace period extensions and waiver of late-fees or penalties so that consumers can retain their coverage through income disruptions that may cause them to delay premium payments.
Navigating Eligibility Challenges
Meanwhile, SBMs are also working through eligibility challenges presented by discrepancies in how supplemental unemployment benefits provided under the Coronavirus Aid, Relief, and Economic Security (CARES) Act are calculated toward eligibility for coverage benefits. Specifically, the law includes a temporary, supplemental benefit of $600 per week, per unemployment recipient.
The law specifies that the $600 not count toward income used to determine eligibility for Medicaid and CHIP, but does not stipulate the same exclusion when determining eligibility for federal marketplace subsidies, including advance premium tax credits (APTCs) and cost-sharing reductions (CSRs). (For more information read: CARES Act Funds Help Consumers, but Create Coverage Eligibility Challenges for States). The discrepancy raises concerns that consumers may either miss out on needed benefits or be held liable for penalties if they inaccurately over- or under-estimate income because of confusion over how to account for the supplemental unemployment income. The discrepancy also poses significant operational challenges for SBMd systems built to be closely coordinate, if not fully integrate, with states’ Medicaid systems. The SBMs continue to work toward solutions to ensure that individuals receive appropriate benefits, especially as so many of their consumers grapple with unexpected and ongoing financial hardship.
As the COVID-19 pandemic continues to evolve, so too will the SBMs as they continue to innovate and lead on strategies to bring affordable coverage to individuals in their states. For more information on the work of the marketplaces explore NASHP’s Insurance Marketplace Resources page.