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Special Enrollment Period FAQs

SEP with Healthcare.gov

CMS announced a Special Enrollment Period (SEP) beginning February 15, 2021 through May 15, 2021.  This is an opportunity to enroll in health coverage through healthcare.gov.

Please see below a few of the FAQ: 

Members will have to “step through” their current application? 
To Access the SEP, existing enrollees will need to open their existing application, review the information in it and make any updates necessary, and then submit the application.

If someone did not complete an application for Marketplace insurance during open enrollment time will they be eligible to complete an application during this SEP for 2021 insurance coverage?
Yes. Starting on February 15, 2021 and continuing through May 15, 2021, Marketplaces using the HealthCare.gov platform will operationalize functionality to make a SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application

When will coverage start for people who enroll using the new SEP? Will they be able to enroll after the 15th of a month and have their coverage start on 1st of the immediately following month?
Coverage will be prospective, with coverage starting the first day of the calendar month following the date of plan selection. For example, if a consumer selects a plan on February 20th, coverage will be effective March 1st

If current enrollees do not have any changes, can they still change plans during the SEP?
Yes, current enrollees will need to step through the application and re-submit the application in order to get an updated eligibility determination and access the SEP. They do not need to report changes to get the SEP.

Is the SEP beginning 2/15/21 like Open Enrollment where you do not need a qualifying SE circumstance?
In order to use this SEP, current enrollees will need to step through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment. This SEP opportunity will not involve any new application questions, or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage.

If a currently enrolled consumer switches to a new plan, does the deductible start over? Is the answer different if the consumer stays with the same carrier?
Issuers have the flexibility to carry over progress towards deductible and other accumulators for consumers who change to a new plan with the same issuer. However, this is not a requirement for issuers and something consumers should be aware of when considering their options.

Are there different criteria to qualify than the annual Open Enrollment Period?
In order to use this SEP, current enrollees will need to step through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment. This SEP opportunity will not involve any new application questions, or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage.

People who enrolled during Open Enrollment will be able to change their plans?
Yes, current enrollees will be able to change to a different plan without restriction based on metal level.

Do people that apply on the last day of the SEP – May 15th, still have 30 days to pick a plan? If after June 1st, the plan would start July 1st, correct?
Yes, people that apply on the last day of the SEP will have 30 days from that date to select a plan, and coverage will start the first of the month following plan selection.

People who are uninsured can apply for enrollment just like they could have done on Nov. 1, 2020
Yes, people who are uninsured and underinsured should apply for coverage through this special enrollment period starting Feb. 15 through May 15. The special enrollment period is available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application.

What is the criteria for eligibility?
This SEP opportunity will not involve any new application questions, or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage.

Marketplace over employer should employer insurance be unaffordable?
This SEP is available to all Marketplace-eligible consumers but as you note, individuals with an offer of employer coverage that is considered affordable and meets the minimum value standard are not PTC-eligible. For more information about how to determine whether an offer of employer coverage is considered affordable and to meet the minimum value standard, please see: https://www.healthcare.gov/have-job-based-coverage/change-to-marketplace-plan/

Will deductibles be reset if you switch plans during this Open Enrollment Period?
Issuers have the option to carry over progress towards deductible and other accumulators for consumers who change to a new plan with the same issuer. However, issuers are not required to do this, and it is something consumers should keep in mind when deciding whether to change plans.

View / download IPHCA’s Special Enrollment Flyer here

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