For the past few months, we’ve commented several times that we’re not sure what’s going to happen with the individual market this fall while continuing to point out that it could be a mess. If you’ve kept up with the news over the past several weeks, now you see why. A number of major carriers have announced that they won’t participate in the federal or state marketplaces in 2017, and those that remain are making a number of premium and plan design adjustments that our clients won’t be too happy with. That’s why it’s probably time for a “sit down” with your individual clients, particularly the ones receiving a premium tax credit. You need to set expectations for them as we head into the ACA’s fourth annual open enrollment period.

In an effort to make the Marketplace attractive for both consumers and insurance companies, Healthcare.gov CEO Kevin Counihan stated in a January 19 press release that CMS is eliminating “several unnecessary special enrollment periods” while clarifying the definitions of other SEPs. He also vowed that CMS will provide “stronger enforcement so that special enrollment periods serve the purpose for which they are intended and do not provide unintended loopholes.”

As you know, the first two enrollment deadlines for 2016 coverage have come and gone. During these last couple of weeks of the annual open enrollment period, people can sign up for coverage to begin on March 1st. We know you’re busy trying to sign up as many people as possible in the last few days, so we’ll keep this short, but we did want to share a couple items with you that may help you better advise your clients and bring in a few more sales.

Special enrollment periods (SEPs) are nothing new. For health insurance agents working with groups, HIPAA regulations have meant that employees and family members who originally waive coverage on a group plan have special enrollment rights if they lose other qualified coverage or have a life event such as marriage, birth or adoption. During these special enrollment periods, employees and their family members usually have 30 days to sign up for the group health plan.

The Affordable Care Act’s advance premium tax credit (APTC) has been wildly successful. It’s helping millions of Americans pay for health insurance purchased through the individual Marketplace. However, something that’s been confusing for many is the fact that it is an advance. The tax credit is based on the estimated amount that an individual believes they will earn in the coming year. This estimate must be made at the time of the insurance purchase, and, of course, the actual amount earned could ultimately be more or less than anticipated.