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Marketplace Auto Enrollment Rule Finalized

Affordable Care Act • September 9, 2014 at 12:00 PM • Written by: Abby Rosenberger

Fotolia_66355339_SIn July, the U.S. Department of Health and Human Services (HHS) announced that Marketplace enrollees would be able to auto-enroll in 2015. This means that consumers will not have to fill out a new application or go back through Healthcare.gov to renew their individual health insurance coverage. The final rules on Marketplace auto enrollment were released at the beginning of the month. While auto enrollment was intended to make things easier for Marketplace consumers, industry experts warn that it could lead to unforeseen premium increases. This article contains an overview of the final rules on Marketplace auto enrollment.

The Final Rules on Marketplace Auto Enrollment

Under the new auto enrollment ruling, Marketplace enrollees who do not indicate otherwise will be re-enrolled in their current Marketplace plan on December 15, 2014. This delay in re-enrollment will give consumers additional time during open enrollment to explore their health insurance options.

Consumers who are auto enrolled will be able to keep their 2014 premium tax credits, so long as they checked the box on their original application to give consent to the IRS to view their tax returns, and their income has not changed significantly.

If an enrollee’s plan is not offered on the Marketplace this year, but is being offered outside of the Marketplace, they will be automatically enrolled in the plan outside of the Marketplace.

Additionally, if the enrollee’s policy has been cancelled altogether, they will be automatically enrolled in a different plan of the same metallic tier and insurance company.

  • If the insurance company does not offer a different plan of the same metallic tier, the consumer will be enrolled in a plan one metallic tier higher than their previous plan.

  • If that is not an option, the enrollee’s coverage will be renewed in “any other plan offered under the product in which the enrollee’s current QHP (Qualified Health Plan) is offered in which the enrollee is eligible to enroll.”

If the enrollee’s premium increases, they are automatically enrolled for the price of the premium increase.

Read the final rule by the U.S. Department of Health and Human Services

How to Avoid Surprise Premium Increases

Since the premium tax credits are based on household income, family size and region, enrollees should report any changes to ensure that their 2015 premium tax credit estimate is accurate.

As the Marketplace enters the second year of operation, more major health insurance carriers are entering the Marketplace or expanding their presence in the Marketplace. For enrollees, this news means more individual health plans to choose from and more competition in many of the state Marketplaces. This increased competition among carriers will help to keep rates down in 2015. To avoid surprise premium increases due to automatic enrollment, Marketplace enrollees should:

  • Consider their options before opting for auto-enrollment

  • Contact the Marketplace to update them about any changes in personal, household, or financial details

  • Shop around to see if any of the new plans available are better suited to their financial or healthcare needs.

Do you have any questions about auto enrollment? Leave a comment below. 

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