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Home ACA Compliance Recapping The ACA’s Special Enrollment Period

Recapping The ACA’s Special Enrollment Period

2 minute read
by Robert Sheen

August 15 was the deadline for Biden’s federal special enrollment period. Preliminary data finds over 2.5 million Americans opted to receive healthcare coverage.

Of the 2.5 million, 1.8 million enrolled in healthcare coverage through the federal health exchange and approximately 723,000 signed up through one of the 15 state-run (including D.C.) health exchanges.

It’s worth noting that this data is reflective through July 30. The real figures are likely much greater as Americans had an additional 15 days after July to enroll.

The special enrollment period’s success can be attributed in part to Biden’s American Rescue Plan, which created greater access to affordable healthcare for Americans. Through the American Rescue Plan, individuals with household incomes up to 150% of the Federal Poverty Level (FPL) can receive healthcare coverage for $0 monthly premiums. In addition, individuals with income at and beyond 400% of the FPL can receive coverage through the ACA marketplace for no more than 8.5% of their household income.

While the federal special enrollment period is over, the effects of the American Rescue Plan on marketplace premium subsidies are slated to run through the remainder of 2021 and for all of 2022. Still, the Biden administration is making strides to make the premium assistance permanent through the American Families Plan.

According to a news release from the U.S. Department of Health and Human Services (HHS), since the start of the federal special enrollment period “more than 2.5 million current enrollees have returned to the Marketplace to find average savings of over $40 per month on their premiums.”

Americans looking to enroll in an ACA health exchange will have to wait until the 2022 open enrollment, which begins November 1. 

A number of changes could be coming between now and then, as a recent rule proposed by the Centers for Medicare and Medicaid (CMS) is currently being routed for approval. 

Included in CMS’ proposal are measures to extend the annual open enrollment period by an additional 30 days. The rule also provides health exchanges with the option to offer special enrollment periods to select low-income individuals. These special enrollment periods will allow individuals with household incomes under 150% of the FPL to receive $0 monthly premiums.

By now it has become abundantly clear that advancements to the ACA are not letting up. With IRS enforcement of the healthcare law increasing, employers should take the time to review their ACA processes to ensure compliance with the ACA’s Employer Mandate.

Under the ACA’s Employer Mandate, employers with 50 or more full-time employees and full-time equivalent employees, known as Applicable Large Employers (ALEs) must:

  • Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV)
  • Ensure that the coverage is deemed affordable based on one of the IRS-approved methods for calculating affordability

Failure to adhere to these two requirements could subject ALEs to Internal Revenue Code (IRC) Section 4980H penalties. Contact us to have your ACA compliance score calculated and find out if you’re currently exposed to any IRS penalty risk.

If your organization needs assistance understanding the complexities of the ACA’s Employer Mandate, download our free guide, the 2021 ACA Essential Guide for Employers.

We’re committed to helping companies reduce risk, avoid penalties, and achieve 100% ACA compliance. For questions about the ACA contact us here.

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