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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules percentages used to calculate the amount of household income a taxpayer is required to contribute to their second lowest cost silver plan for tax years 2021
and 2022.49 The applicable percentages are used in combination with factors including annual household income and the cost of the benchmark plan to determine the PTC amount for which a taxpayer can qualify to help pay for a QHP on an Exchange for themselves and their dependents.50 These decreased percentages generally result in increased PTC for PTC-eligible taxpayers. For those with household incomes no greater than 150 percent of the FPL, the new applicable percentage is zero. As a result of these changes, many lowincome consumers whose QHP coverage can be fully paid for with APTC have one or more options to enroll in a silverlevel plan without needing to pay a premium after the application of APTC.
All of these consumers, if eligible to enroll through an Exchange and to receive APTC, will qualify for CSRs to enroll in a silver plan with an AV of 94
percent.51
We propose that this special enrollment period be available at the option of the Exchange, in order to allow State Exchanges to decide whether to implement it based on their specific market dynamics, needs, and priorities. Additionally, we propose that Exchanges on the Federal platform will implement this special enrollment period by providing qualified individuals who are eligible with a pathway to access it through the HealthCare.gov application. We propose that implementation in Exchanges on the Federal platform be consistent with current special enrollment period policy and operations, in particular such that there is no limitation on how often individuals who are eligible for this special enrollment period can obtain or utilize it.52 Consistency in this area will mitigate consumer and other stakeholder confusion and simplify Exchange operations. To provide Exchanges with flexibility to prioritize ensuring that qualifying individuals are able to obtain coverage through this special enrollment period quickly 49 Public
Law 1172.
26 CFR 1.36B3g for more information on the applicable percentage and its relationship to the PTC.
51 See 155.305g2 and 156.420a.
52 For example, those who qualify for the special enrollment period per 155.420d8 for qualifying individuals who gain or maintain status as an Indian, as defined by section 4 of the Indian Health Care Improvement Act, may change their plan selection multiple times each month, noting that only the last plan selection before the applicable cutoff date for coverage each month will take effect for the month in question.

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following plan selection, or to implement this special enrollment period in keeping with their current operations, we propose to add a new paragraph at 155.420b2vii to provide that the Exchange must ensure that coverage is effective in accordance with paragraph b1 of this section or on the first day of the month following plan selection, at the option of the Exchange.
We also propose to add a new paragraph at 155.420a4iiD to provide that an Exchange must permit eligible enrollees and their dependents to change to a silver level plan, and to amend paragraph 155.420a4iii, which provides other plan category limitations for other special enrollment periods, to provide that these other plan category limitations do not apply to enrollees or dependents who qualify for the proposed special enrollment period.53 While we expect that most consumers who qualify for this special enrollment period will select a silver level plan because based on their household income, they will be eligible to enroll in a silver level plan with an actuarial value of 94 percent, as further discussed below, we believe that ensuring that current Exchange enrollees do so through plan category limitations will help to mitigate adverse selection. Finally, we propose to add a new paragraph at 147.104b2iG to specify that issuers are not required to provide this special enrollment period in the individual market with respect to coverage offered outside of an Exchange, because eligibility for the special enrollment period is based on eligibility for APTC, and APTC cannot be applied to coverage offered outside of an Exchange.
The APTC benefit changes under the ARP make affordable coverage available to more uninsured people. However, if past trends continue, we believe that some consumers who qualify for these benefits under the ARP may continue to forgo enrollment in premium-free coverage due to a lack of awareness of the opportunity to enroll or a misconception about what the coverage would cost. For example, a February 2021 HHS Assistant Secretary for Planning and Evaluation ASPE issue brief 54 indicates that, as of 2018, 20
53 This provision would not prevent enrollees who qualify for the new special enrollment period from changing to a plan of any category through a special enrollment period that provides this flexibility, including the special enrollment periods at 155.420d4, 8, 9, 10, 12, and 14.
54 Trends in the U.S. Uninsured Population, 20102020. Office of the Assistant Secretary for Planning and Evaluation ASPE, February 11, 2021:
https aspe.hhs.gov/system/files/pdf/265041/
trends-in-the-us-uninsured.pdf.

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percent of the uninsured had a household income no higher than $35,000, which, in 2018, was under 150
percent of the FPL for households with four or more members.55 A recent analysis of American Community Survey ACS and U.S. Census data also indicates that families with low incomes are more likely to be uninsured, and that in 2019, more than 70 percent of uninsured adults said that they were uninsured because the cost of coverage was too high. It also noted that in 2019, almost 70 percent of uninsured, nonelderly adults had lacked coverage for more than a year, and that this group may be particularly difficult to reach with outreach and education efforts.56
Therefore, while HHS will undertake extensive outreach and engagement efforts to promote enrollment during the open enrollment period for 2022
coverage and to help ensure consumer awareness of existing special enrollment periods for which they may qualify, given the established challenges with promoting awareness of access to coverage among low-income consumers, we believe additional enrollment opportunities for low-income consumers are appropriate and in the best interest of low-income consumers.
The proposed monthly special enrollment period policy would align with E.O. 14009, which requires federal agencies to identify and appropriately address policies that create barriers to accessing ACA coverage, including access through mid-year enrollment.
In addition to providing certain lowincome individuals with additional opportunities to newly enroll in free or low-cost coverage that is available to them, we believe this special enrollment period may help consumers who lose Medicaid coverage regain health care coverage. These consumers can already qualify for a special enrollment period due to their loss of Medicaid coverage, per 155.420d1. Additionally, Exchanges could provide consumers who do not learn of their opportunity to enroll in Exchange coverage until after their 60-day special enrollment period 55 2017 Federal Poverty Guidelines. ASPE:
https aspe.hhs.gov/2017-poverty-guidelines. We refer to 2017 FPL information to determine APTC
eligibility for 2018 because, per 26 CFR 1.36B1h, the FPL for computing the PTC for a taxable year is the FPL in effect on the first day of the initial or annual open enrollment period preceding that taxable year. For example, ASPE released 2020 FPL
information in January 2020, and so 2020 FPL
information applies during the 2020 open enrollment period for 2021 coverage.
56 Key Facts about the Uninsured Population:
Kaiser Family Foundation; Nov 06, 2020, https
www.kff.org/uninsured/issue-brief/key-facts-aboutthe-uninsured-population/. https www.kff.org/
uninsured/issue-brief/key-facts-about-theuninsured-population/.

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