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Considerations as the US Contemplates a Covid-19-Driven Special Enrollment Period for Affordable Care

It’s all over the news. The White House is considering the launch of a special enrollment period (SEP) for people to sign up for health coverage under the Affordable Care Act (ACA) in response to the Coronavirus crisis. Extending opportunities for people to get access to care when they need it, especially during these unpredictable and scary times is a good thing; no, it is a great thing! It is meant to:

a) Keep the healthy people healthy

b) Identify and support sick people who could spread illness to others, and

c) Give care to people who may suffer and potentially die without appropriate coverage.

While this initiative may bode well for uninsured Americans who may need healthcare in the coming days, weeks, and even months, it bears unique implications for consumers and stakeholders across the system:

Insurers

Those who offer ACA coverage spend considerable time and expenses planning for, and marketing to, potential enrollees during the standard Open Enrollment Period (OEP) that takes place during a fixed period (November 1 to December 15) annually. Benefits are structured and rates are set based upon current market conditions and associated risks. While a sudden influx of new members may seem like a good thing, insurers may find a potential spike in demand for coverage which might be more than they can address. The biggest unknown variable is who will take advantage of this SEP and enroll, the sick or the healthy? Preferably (and likely) it will be a mix of both so that insurers can continue to manage risk and balance premium funding with claim payments. Too many new sick members will put a strain on insurers’ finances and have them lining up to obtain assistance under a federal support program. While there is no such thing as having too many healthy members, having the scales overwhelmingly tip in this direction may be an indicator that the White House’s move might miss the mark.

The Uninsured

Consider those who lose coverage because of a layoff. They will be notified of their SEP and be given a chance to enroll in individual coverage. Others, who are aware of their coverage options, but have chosen not to enroll until now, may find it easy and convenient to take advantage of this offer. A third group of consumers who haven’t enrolled because they cannot afford coverage, may not see things differently and may choose to continue to do without. Finally, there are the uninsured who can benefit from fully subsidized coverage, but do not know how to enroll and do not understand their options. For this effort to be truly successful, educating all consumers about the SEP, including enrollment assistance, will be critical.

Insurers spend months planning communications and messaging to inform and educate the public about their unique value proposition prior to the OEP. If this SEP comes to pass, the time to act is now, and campaign communication, engagement, and activation strategy needs to be defined, crafted, and put in place immediately to ensure insurers can play a key role in support and recovery from Covid-19 across the US.

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