Special Enrollment Period for Eligible Applicants

Special Enrollment Period for Eligible Applicants

From HealthInsurance.org: In September 2021, the U.S. Department of Health & Human Services finalized a new special enrollment period (SEP) in states that use HealthCare.gov (optional for other states), granting year-round enrollment in ACA-compliant health insurance if an applicant’s household income does not exceed 150% of the federal poverty level (FPL) and if the applicant is eligible for a premium tax credit (subsidy) that will cover the cost of the benchmark plan.

This SEP became available on the HealthCare.gov website (and enhanced direct enrollment entity websites) as of March 21, 2022. It was available prior to that only by calling the HealthCare.gov call center and completing the application over the phone. But it is now available online as well. Visitors to HealthCare.gov need to select “see if you can enroll” and then select the option that says “Medicaid, CHIP, or a new Special Enrollment Period based on income.” The prescreener tool will then ask questions to determine whether the person/household’s income is in the eligible range. If so, the special enrollment period opportunity will allow them to proceed with the enrollment. Enhanced direct enrollment entities have similar enrollment pathways.

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