The Impact of COVID-19 on State-Based Health Exchange Enrollment

March 9, 2020, Seattle and King County in Washington reported 190 confirmed COVID-19 cases and 22 deaths, increases of 116 and 20 over the preceding day. The next day, Washington’s Health Benefit Exchange announced a special enrollment period. Within the next two weeks, 11 state exchanges followed suit, with Idaho’s Your Health Idaho being the lone holdout among state-based marketplaces. The federal Healthcare.gov exchange also did not implement a special enrollment period in response to the COVID-19 pandemic.

Though special enrollment period specifics varied among the state exchanges, most allowed any uninsured residents to enroll in an insurance plan without any qualifying events. Here’s a look at what each state’s special enrollment period looked like and what impact it had on enrollment in the state’s health insurance exchange.

California

Special Enrollment Period: March 20, 2020, to July 31, 2020.

On March 20, 2020, Covered California, the state’s health insurance exchange, announced that they had opened enrollment to any eligible uninsured individuals in need of health care coverage. Anyone meeting the state’s eligibility requirements – which were similar to those in place during the annual open enrollment period – could sign up for coverage through June 30, 2020. That date was later extended to July 31, 2020. After selecting a plan, coverage would begin the first of the month after that selection. Additionally, the state announced that all health plans in the exchange covered telehealth visits. Also, all necessary screening and testing for COVID-19 were free of charge.

What impact did that have on enrollment in the plan? The state announced on May 20th that enrollment had already increased by more than 123,000 people, a pace of signups that was nearly 2.5 times higher than the level the exchange saw during the same period in 2019.

Colorado

Special Enrollment Period: March 20, 2020 to April 30, 2020

Like California, Colorado announced a special enrollment period for their Connect for Health Colorado state exchange with a March 20, 2020, start date that was originally to end on April 3, 2020. That date was later extended to April 30, 2020. Individuals who selected a plan on or before April 3 had coverage effective April 1. Anyone after that date had insurance coverage effective May 1, 2020. Eligibility was based on losing coverage or being uninsured during the COVID-19 outbreak.

The end result of the special open enrollment period was 14,263 new enrollees.

Connecticut

Special Enrollment Period: March 19, 2020 to April 17, 2020

On March 19, 2020, Access Health Connecticut announced a new special enrollment period effective from March 19, 2020, to April 2, 2020. The deadline was later extended to April 17, 2020. The special enrollment period was limited to the uninsured who were lawfully present in the US and not incarcerated. For those who enrolled on or before the original April 2, 2020, deadline, coverage began April 1, 2020. For those who enrolled after April 2, coverage was effective May 1. Connecticut limited enrollment to sign up by phone; enrollment couldn’t occur on the website.

On June 1, 2020, Connecticut announced that more than 37,000 residents had enrolled during the COVID-19 crisis.

Idaho

Special Enrollment Period: None

Idaho was the only state-based health insurance exchange that chose not to create a separate open enrollment period in response to the COVID-19 outbreak. As a result, those uninsured in Idaho were not eligible to enroll in a plan. However, Idaho did relax the documentation requirements for those who lost employer-sponsored health insurance during the outbreak.

Maryland

Special Enrollment Period: March 16, 2020, to July 15, 2020

On March 13, 2020, Maryland announced a special open enrollment period for the Maryland Health Connection insurance marketplace. Enrollment was open to any uninsured resident and initially scheduled to close April 15. It was later extended to July 15, 2020. Any enrollment made through the 15th of the month had an effective date of the first of that month.

On June 9 Maryland announced that that nearly 40,000 residents had received health coverage – including Medicaid coverage – during the special enrollment period. Of those 40,000, 35% enrolled in a private health insurance plan through the Maryland Health Connection insurance marketplace.

Massachusetts

Special Enrollment Period: March 11, 2020, to July 23, 2020

On March 11, 2020, the Massachusetts Health Connector announced that uninsured residents could apply for coverage during a special enrollment period running through April 25. That enrollment period was later extended to July 23, 2020. Additionally, the Division of Insurance announced on March 6 that health insurers would be required to cover the cost of testing and treatment for members who may be affected by COVID-19, including not charging deductibles and co-pays for those services.

On April 28, 2020, Massachusetts announced that more than 20,000 new enrollments occurred since the start of March.

Minnesota

Special Enrollment Period: March 23, 2020, to April 21, 2020

On March 20, 2020, MNsure, Minnesota’s state health insurance exchange, announced a special enrollment period beginning March 23, 2020, and running through April 21, 2020. Any uninsured that enrolled during the special enrollment period were able to have coverage effective April 1. Additionally, all four medical insurance companies that sell health insurance plans in the state exchange waived co-pays, deductibles and co-insurance related to COVID-19 diagnostic testing and cost sharing for in-network COVID-19 hospitalization.

On April 22, 2020, Minnesota announced that 9,482 Minnesotans enrolled in private health insurance plans through MNSure during the special enrollment period. Of those, 6,023 were COVID-19 emergency enrollees.

Nevada

Special Enrollment Period: March 17, 2020 to May 15, 2020

On March 19, Nevada’s Silver State Health Insurance Exchange announced a limited time exceptional circumstance special enrollment period for qualified Nevadans. With a deadline to enroll of April 15, 2020, the enrollment period enabled qualified uninsured Nevadans to enroll in one of the state’s health insurance plans. The state later extended the special enrollment period to May 15, 2020. Those who enrolled on or before April 30 received coverage effective May 1. Those enrolled between May 1 and May 15 earned coverage effective June 1. Additionally, all plans sold by the exchange covered COVID-19 diagnosis and treatment. They also covered the ten essential health benefits mandated by the Affordable Care Act.

On May 19, 2020, Nevada announced that 5,479 individuals were enrolled in health insurance plans during the special enrollment period.

New York

Special Enrollment Period: March 16, 2020, to June 15, 2020.

On March 16, 2020, the NY State of Health, New York’s state health exchange, announced the immediate creation of a special enrollment period through April 15, 2020, to enable New Yorkers to enroll in insurance coverage. Additionally, all New York insurers agreed to waive cost-sharing for COVID-19 testing. The state also later extended the special enrollment period to June 15, 2020.

New York hasn’t yet released enrollment data relative to the special enrollment period.

Rhode Island

Special Enrollment Period: March 14, 2020, to April 30, 2020.

On March 14, 2020, HealthSource RI adopted a limited-time special enrollment period allowing uninsured Rhode Islanders to purchase coverage through April 15, 2020. Enrollees’ insurance coverage began on the first of the month following the application. The state later extended the special enrollment period to April 30, 2020.

Rhode Island hasn’t yet released enrollment data relative to the special enrollment period.

Vermont

Special Enrollment Period: March 20, 2020, to August 14, 2020.

Vermont created a special enrollment period from March 20, 2020, to June 15, 2020. The state later extended the enrollment period to August 14, 2020. The enrollment period enables uninsured Vermonter to sign up for a qualified health plan through the state’s health insurance exchange, Vermont Health Connect.

Vermont hasn’t yet released enrollment data relative to the special enrollment period.

 

Washington

Special Enrollment Period: March 10, 2020, to May 8, 2020.

On March 10, 2020, Washington announced a limited-time special enrollment period for those without insurance. The state initially set the enrollment period to end after April 8, 2020. It later extended the enrollment deadline to May 8, 2020.

On May 15, 2020, Washington reported that 22,000 individuals had signed up during the special enrollment period, including 7000 uninsured Washington residents who enrolled in qualified health plans through the COVID-19 special enrollment period. The state indicated the number of people signing up had doubled compared to the same time period in the previous year.

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