Open Enrollment for the federal Health Insurance Marketplace, also known as Healthcare.gov, comes at a unique time when patients around the country are losing Medicaid and CHIP coverage due to the Medicaid unwinding. Fortunately, Community Health Centers can provide assistance to people looking for health coverage! Health centers are established and trusted members of their communities who not only have the expertise to conduct outreach but also have the knowledge and skills to help patients and families navigate a complex health system to protect their access to quality health care services.
Open enrollment extends through January 15, 2024
Currently, 29 states utilize the federal Health Insurance Marketplace while 19 states have their own State-Based Marketplace (SBM), and three states have a SBM and use the Federal Platform. This is the time for patients who need health insurance to select and enroll in a health plan for 2024.
The open enrollment period for Healthcare.gov started on November 1, 2023, and extends through January 15, 2024. Consumers must enroll by December 15th, 2023, for their new coverage to start January 1, 2024. States with their own Marketplaces may have different enrollment period end dates.
Changes in Medicaid enrollment policies mean millions are losing coverage
This year, many more Americans specifically health center patients may find themselves in need of Marketplace coverage.
Nationwide, nearly 94 million Americans were on Medicaid or CHIP prior to the unwinding of the COVID-19 Public Health Emergency (PHE). Given the end of the PHE, many people are now losing Medicaid or CHIP coverage. In fact, nearly 11.77 million Medicaid enrollees have been disenrolled from Medicaid nationwide as of December 1.
Are people disenrolled from Medicaid out of options for health care coverage? No! An estimated 71% of people disenrolled from Medicaid were terminated for procedural reasons – this related to more paperwork shortcomings rather than no longer meeting Medicaid eligibility requirements. It is also estimated that nearly one-third of people losing Medicaid coverage are eligible for tax credits on the Marketplace.
Health centers serve about 31.5 million patients annually. Of those patients, about 14.5 million are on Medicaid and about 6.1 million are privately insured.
As health center patients and community members are disenrolled from Medicaid or CHIP coverage, they need to know that their health center is a place where they can get help.
Health centers are here to help
In 2022, health centers employed nearly 7,500 outreach and enrollment staff who provided nearly 4 million enrollment assists. This staff includes outreach workers, eligibility assisters, Marketplace Navigators, Certified Application Counselors, Community Health Workers, benefits counselors, and other critically important staff. Both health centers and Primary Care Associations receive HRSA funding to support outreach and enrollment efforts. There are also about 17 health centers and PCAs that are CMS Navigator Awardees, which means they receive funding to employ Marketplace Navigators.
Key messages about the Health Insurance Marketplace
This year, CMS has several key messages for assisters to leverage when speaking with consumers:
- Coverage is Affordable!
- The Inflation Reduction Act (IRA) has helped more people qualify for help purchasing quality health coverage. CMS estimates that 4 out of 5 HealthCare.gov customers will be able to find a plan for $10/month or less with financial help.
- Quality Plans!
- Qualified Health Plans listed on the Marketplace are required to provide coverage for doctor visits, emergency care, behavioral health care, preventive care, hospital care, maternity care, and prescription drugs. Search for available plans at healthcare.gov.
- Help is Available!
- This is where health centers come in! Consumers can access Navigators and other assisters in every state on the Marketplace. To find local help go to https://localhelp.healthcare.gov.
- Going to their nearest health center is a great option because of the direct and impartial information they can provide to their communities. Health centers provide each patient with an individual assessment to determine their eligibility for health insurance, striving to connect vulnerable patients with the most affordable and comprehensive coverage they are qualified for. Health center patients have a broad range of health insurance coverage, from Medicare and Medicaid to private insurance.
- Sign Up for Coverage!
- All consumers shopping for health insurance coverage — even those who currently have coverage through the Marketplace — should enroll or re-enroll by logging in to HealthCare.gov and CuidadodeSalud.gov or call 1-800- 318- 2596 (TTY is 855-889-4325) to fill out an application and enroll in a Marketplace plan.
- Free help is available 24 hours a day/ 7 days a week, and assistance is available in over 200 languages.
- The deadline to sign up for January 1 coverage is December 15, 2023. The final deadline to sign up for coverage is January 15th, 2023. If people miss this deadline, they may be eligible for a Special Enrollment Period if they have a qualifying life event, such as losing Medicaid or CHIP since March 31, 2023.
Show off your health center’s great work!
During this week, please share photos on social media of outreach and enrollment activities or spotlight a staff member doing this incredible work at your health center, PCA or HCCN. Be sure to tag @nachc and use the hashtags #valueCHCs #MarketplaceOE and #GetCovered so we can celebrate the amazing work community health centers are doing during Open Enrollment!
And in case you missed it, please visit NACHC’s webpage for our recent webinar resources on Open Enrollment and Medicaid Renewals!