Insurance enrollment

HHS proposals to expand access to health insurance membership

The Department of Health and Human Services (HHS) has proposed rule changes to make it easier for people to enroll in health coverage. These changes include a proposal to extend the annual open enrollment period for individual / family health coverage, as well as a proposal for year-round enrollment for low-income households.

This article explains these proposals, including their origin and what consumers can expect in terms of access to health insurance.

Focus on expanding access to health coverage

In January 2021, shortly after taking office, President Biden signed Executive Decree 14009, titled “Executive Ordinance on Strengthening Medicaid and Affordable Care Law”.

This executive order has been a guiding force behind much of the Biden administration’s action on health care reform. This includes the special COVID-related enrollment period in 2021 and administration support for American Rescue Plan health insurance subsidy improvements.

In June 2021, in accordance with this decree, the HHS published proposed new rules regarding health insurance markets (exchanges) and health coverage 2022.

The rulemaking process for the year 2022 was unusual in that it took place under two separate administrations with very different ideas on how healthcare reform should be handled.

Under Trump administration, HHS proposed 2022 rules in late 2020 then finalized some in January 2021, shortly before President Biden took office.

Under the Biden administration, the HHS finalized some of the rest of the proposed rules a few months later. But they made it clear at this point that they also intended to come up with new or additional rules.

There is a rule making process that needs to be followed. The HHS must propose rule changes, accept public comments on the proposals, and then publish the final rules.

The new proposal was released in June 2021. It includes several provisions that would override the rules finalized by the previous administration in January 2021. But it also includes proposals for new provisions designed to make it easier for people to sign up for health coverage.

Extension of registration open until January 15

For people who purchase their own health insurance, either through exchange or directly from a health insurance company, there is an open annual enrollment period during which coverage can be purchased.

Outside of this window, an eligible life event is required to access a special registration period. But during open enrollment, anyone can purchase coverage.

These same general rules apply to employer-sponsored health insurance, but employers set their own open enrollment periods, so the specific timeframe varies from employer to employer.

Prior to 2014, there was no registration window open in the individual / family (self-purchased) health insurance market. People could apply for coverage whenever they wanted, but insurers in almost every state used medical underwriting to determine eligibility and prices.

This is no longer the case, coverage is guaranteed, regardless of medical history. But registration without a qualifying event is also limited to the annual open registration period (the special COVID-related registration period in 2021 is an exception to the normal rules).

The specifics of the open registration window have varied over time. The first year the window lasted six months. But it was gradually shortened thereafter, and over the past four years it has lasted just over six weeks: from November 1 to December 15.

This is the window that applies in all states that use as their marketplace. In DC and 14 states (growing to 17 states as of fall 2021), the state manages the exchange and can extend the open registration as it sees fit. Most of these state-run exchanges tend to have longer registration windows each year, although this varies from state to state.

In the proposed new rules, the HHS is asking for an extended open enrollment period. They plan to add an extra month to the end of the regular sign-up window so that it ends on January 15th instead of December 15th.

If finalized, the window from November 1 to January 15 would apply nationwide, starting with the open registration window that begins in fall 2021. States that manage their own exchanges would still have the option. add other extensions. Some are currently extending registration until the end of January, and they could still do so.

The HHS notes that people using should always register by December 15 in order to have coverage starting January 1 (states that run their own exchanges may set their own deadlines). But then people could sign up between December 16 and January 15, with coverage starting February 1.

HHS recognizes that there are pros and cons to this. Some people may miss the deadline and end up with only 11 months of coverage instead of 12, which is not ideal. But the extended registration window would give registration assistants more time to help people register.

It would also give people the option to change coverage after the start of the new year. This is important when someone’s coverage changes for the new year and they haven’t noticed the changes in advance (this can include changes to monthly premiums, grant amounts, provider network, prescription form, health benefits, etc.).

Under the current rules, people in this situation are stranded with their blanket at this point. But if registration is extended until mid-January, it would give people a little more time to choose a different plan that might better meet their needs after noticing the changes that took effect on January 1.

Year-round registration for low-income households

HHS also offered a much more extended registration option for low-income households. Under the proposed rules, applicants could purchase year-round coverage, provided they are eligible for premium grants and their household income does not exceed 150% of the poverty level.

For 2022 coverage in the continental United States, that would represent an annual income of $ 19,320 for a single person and $ 39,750 for a family of four (the amounts are higher in Alaska and Hawaii).

HHS is not sure if this could be implemented for 2022; if finalized, it may have to wait until 2023. They are also seeking extensive public comment on this special listing opportunity, soliciting comments regarding the potential risk of adverse selection (healthy people avoid coverage while sicker people choose greater coverage).

They also want to know whether this enrollment option should be available indefinitely or only as long as the US bailout subsidy enhancements are available (currently until 2022, but this could be extended under future legislation). .

The American Rescue Plan makes referral money plans premium-free (or nearly free, depending on state insurance mandates) for households with incomes reaching 150 percent of the poverty line. As long as this provision remains in place, these households can generally choose from two no-premium silver plans and, in most cases, multiple no-premium bronze plans.

But many Americans eligible for these no-premium plans are unaware of the financial assistance available to them. HHS is dedicated to raising awareness on this topic. Nevertheless, they also believe that the enrollment opportunities throughout the year would make it easier for people to take advantage of the benefits available.

It should be noted that Medicaid registration already operates year round. In most states, this means adults with incomes reaching 138 percent of the poverty line can enroll in Medicaid at any time. In the dozen states where the Medicaid expansion has not been implemented, eligibility is much more limited, creating a coverage gap.

Enrollment in the Children’s Health Insurance Program (CHIP) is also available year-round, providing eligible children with continued access to coverage.

If the HHS finalizes the year-round enrollment opportunity for eligible grant applicants whose household income reaches 150% of the poverty level, it will become available in states that use Other states that run their own stock exchanges would have the choice to follow or not, at their discretion.


The rule changes proposed by the Ministry of Health and Social Services are intended to facilitate registration for health coverage. The annual open registration period would be extended until January 15. They also offer year-round registration for households that represent up to 150% of the poverty level.

A word from Verywell

Throughout 2021, the HHS has made it clear that expanding access to health insurance coverage is a priority. Substantial additional funding has been made available for enrollment assistance starting in the fall of 2021. HHS also wants to give people extended opportunities to sign up for coverage.

If you are uninsured or know someone who is uninsured, it is worth taking a moment to check your options on You might be surprised at how affordable the health plans available are.