HHS Rule Changes to Expand Access to Health Insurance Enrollment

The Department of Health and Human Services (HHS) has finalized some rule changes intended to make it easier for people to enroll in health coverage. These changes include an extension of the annual open enrollment period for individual/family health coverage, as well as a year-round enrollment opportunity for low-income households.

This article explains these rule changes, including how they came to be and what consumers can expect in terms of access to health insurance.

Focus on Expanding Health Coverage Access

In January 2021, shortly after taking office, President Biden signed Executive Order 14009, titled the “Executive Order on Strengthening Medicaid and the Affordable Care Act.”

This executive order has been a guiding force behind much of the Biden administration’s action on healthcare reform. This includes the COVID-related special enrollment period in 2021 and the administration’s support for the American Rescue Plan’s health insurance subsidy enhancements.

In June 2021, in keeping with that executive order, HHS published some new proposed rules related to the health insurance marketplaces (exchanges) and 2022 health coverage.

The rulemaking process for the 2022 year was unusual in that it happened under two separate administrations with very different ideas about how healthcare reform should be handled.

Under the Trump administration, HHS had proposed the 2022 rules in late 2020 and then finalized some of them in January 2021, shortly before President Biden took office.

Under the Biden administration, HHS finalized some of the rest of the proposed rules a few months later. But they clarified at that point that they also intended to propose some new or additional rules. (There’s a rulemaking process that must be followed. HHS has to propose the rule changes, accept public comments on the proposals, and then issue final rules.)

The new proposal was issued in June 2021 and finalized in September 2021. It includes several provisions that would roll back rules finalized by the prior administration in January 2021. But it also includes new provisions designed to make it easier for people to enroll in health coverage.

Extending Open Enrollment Through January 15

One of the rule changes was to extend the annual open enrollment period for people who buy their own health insurance, so that it continues through January 15 instead of ending on December 15. (This deadline is applicable in most states, but state-run exchanges can set their own enrollment windows and some have different deadlines.)

The annual open enrollment period applies to coverage purchased through the exchange or directly from a health insurance company. Outside this window, a qualifying life event is necessary to have access to a special enrollment period. But during open enrollment, anyone can purchase coverage.

These same general rules apply to employer-sponsored health insurance, but employers set their own open enrollment periods, so the specific time frame varies from one employer to another.

Before 2014, there was no open enrollment window in the individual/family (self-purchased) health insurance market. People could apply for coverage whenever they wanted, but insurers in nearly every state used medical underwriting to determine eligibility and pricing.

That’s no longer the case—coverage is guaranteed issue, regardless of medical history. But enrollment without a qualifying event is also limited to the annual open enrollment period.

The specifics of the open enrollment window have varied over time. The first year, the window lasted six months. But it was gradually shortened after that, and for the four years prior to 2022, it lasted just over six weeks: November 1 through December 15.

However, starting with the enrollment window for 2022 coverage, the deadline was pushed out to January 15 in all states that use HealthCare.gov (states that run their own exchange can set their own deadlines; most use January 15 or a later date, but Idaho has continued to have a December 15 deadline).

People using HealthCare.gov (and many of the state-run exchanges) still have to enroll by December 15 in order to have coverage effective January 1. But there's also an option to enroll or switch plans between December 16 and January 15, with coverage effective February 1.

HHS acknowledged that there are pros and cons to this. Some people might miss the initial deadline and end up with only 11 months of coverage instead of 12, which is not ideal. But the extended enrollment window does give enrollment assisters more time to help people enroll.

It also gives people a chance to switch their coverage after the start of the new year. This is important when a person’s coverage changes for the new year and they didn’t notice the changes in advance (this can include changes to monthly premiums, subsidy amounts, provider network, the prescription formulary, health benefits, etc.).

Year-Round Enrollment for Low-Income Households

HHS also finalized a much more extended enrollment opportunity for low-income households. Under the new rules, applicants can enroll in coverage year-round, as long as they are eligible for premium subsidies and their household income isn’t more than 150% of the poverty level.

For 2023 coverage in the continental United States, that amounts to $20,385 in annual income for a single person and $41,625 for a family of four (the amounts are higher in Alaska and Hawaii).

This extended enrollment opportunity for low-income applicants applies for as long as benchmark silver plans continue to be premium-free (or nearly free, depending on state insurance mandates) for households with income up to 150% of the poverty level.

It's available in states that use HealthCare.gov, but most of the state-run exchanges also offer this enrollment opportunity or something similar (some extend it to higher income levels, due to the availability of additional state-funded subsidies).

The American Rescue Plan ensures that people with household income up to 150% can enroll in the benchmark silver plan with zero premium, and the Inflation Reduction Act extended that provision through 2025, which means that the year-round enrollment opportunity for low-income applicants will also continue through 2025.

Under the American Rescue Plan and Inflation Reduction Act, households with income up to 150% of the poverty level can generally select from among two premium-free silver plans and, in most cases, several premium-free bronze plans.

But many Americans who are eligible for these premium-free plans are not aware of the financial assistance available to them. HHS is dedicated to outreach on this topic. Still, they also feel that year-round enrollment opportunities make it easier for people to take advantage of the available benefits.

It’s noteworthy that Medicaid enrollment already runs year-round. In most states, that means that adults with income up to 138% of the poverty level can enroll in Medicaid at any time. In the dozen states where Medicaid expansion has not been implemented, eligibility is much more limited, creating a coverage gap.

Children’s Health Insurance Program (CHIP) enrollment is also available year-round, providing eligible kids with ongoing access to coverage.

Summary

Rule changes finalized by the Department of Health and Human Services are designed to make it easier to enroll in health coverage. The annual open enrollment period has been extended to January 15. And they also created a year-round enrollment for households that earn up to 150% of poverty level.

A Word From Verywell

Under the Biden administration, HHS has made it clear that expanding access to health insurance coverage is a priority. Substantial additional funding has been made available for enrollment assistance starting in the fall of 2021. And HHS has also implemented rule changes to give people extended opportunities to enroll in coverage.

If you’re uninsured or know someone who is uninsured, it’s worth taking a moment to check out your options on HealthCare.gov. You might be surprised at how affordable the available health plans are.