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I’m sharing my experience from working with dozens of high-performing health plans to help you make the most of the Special Enrollment Period (SEP) and know what’s important about ACA 2.0.

The new 3-month (SEP) and a renewed Affordable Care Act has created a unique opportunity for Health Plans. They can expand their footprint and provide a best-in-class consumer experience to millions of Americans.

The Current Situation for the SEP and the ACA

As the American population strengthens and regains its footing after one of the most difficult periods in modern history as a result of the COVID-19 pandemic, so does the Affordable Care Act (ACA).

With the introduction of a Special Enrollment Period (SEP), a revitalized marketing budget, and proposed changes to the subsidy structure for health insurance premiums, the Biden Administration is going all-in to create ACA 2.0 or Bidencare. With these changes and the consumer sitting in the center of these policies, health plans have a significant opportunity and responsibility within this complex ecosystem. In this blog, I share some observations related to health plans operating in the ACA Marketplace and considerations as we approach this SEP.

The Most Successful Health Plans Take A Member-Obsessed Approach

Health plans are obsessed with their members. High-performing health plans focus on consumer experiences. A few examples:

  • Leading plans have offered significant grace period extensions and payment plans during the COVID-19 pandemic.
  • Medicaid and community-based plans, who are used to serving under-served populations, aggressively offer ACA plans to fulfill a higher good for the community.
  • Many plans have created premium incentives for completing healthy activities and preventative healthcare.

The Few Things You Should know about the 2/15 – 5/15 Special Enrollment Period

The SEP runs from Monday, February 15, to May 15. Health plans need to consider a few front and back-end changes. During SEP, issuers should:

  • Forego any documentation validation normally required outside of Open Enrollment.
  • Configure front-end portals and back-end enrollment workflow and establish scripting to support members and brokers to navigate this SEP.
  • Halt any SEP verification notices from being sent to members that could lead to abrasion.
  • Update user portals to include banners and callouts for the SEP, especially for any vulnerable populations.

How Will the SEP Impact Member Growth and Retention in 2021?

As a recent White House briefing stated, “Over 30 million Americans remain uninsured, preventing many from obtaining necessary health services and treatment. “

This large group of consumers will have the ability to shop and enroll in Marketplace plans during SEP. They can also change their existing plan or enroll through another issuer. This could make or break existing financial projections for health plans, depending on how issuers respond and how well they can support their members.

Membership usually peaks in January and declines up to 20% by year-end, but this SEP may represent a growth and retention opportunity. because during Open Enrollment we observed the highest retention rates in ACA plan members to date, up 16.5% from the prior year. SEP could further bolster retention rates.

I look forward to seeing the number of changes processed as a result of SEP, considering the administration’s $50M budget to promote enrollment through the exchange.

The Path to Bidencare – How will ACA 2.0 Impact Issuers?

I expect the Biden administration’s changes to ACA will result in greater ACA enrollment.

As part of the COVID-19 relief package, “Bidencare” would increase subsidies for individuals whose income is 400% above the federal poverty line and ensure no member would pay more than 8.5 percent of their income on their health insurance premium. The current value is ~10 percent.

By increasing subsidies and lowering barriers to entry, Bidencare or ACA 2.0 may provide an even greater opportunity for health plans to cover more members while building a sustainable business model going forward.