New special enrollment period for health coverage: What you need to know

Through an executive order signed by President Biden, the Centers for Medicare and Medicaid Services (CMS) recently announced a new special enrollment period (SEP) for individuals and families to enroll in Affordable Care Act (ACA) health coverage via healthcare.gov. Here is what you need to know about this new SEP:

What is the new SEP?

Toward the end of every year, there is an open enrollment period that allows people to apply for and enroll in individual or family coverage through the ACA’s Health Insurance Marketplaces. The 2020 open enrollment period ended on December 15, 2020.

In response to the ongoing COVID-19 pandemic and the impact it has had on Americans’ finances and health, the Biden administration and CMS “determined that the COVID-19 emergency presents exceptional circumstances for consumers in accessing health insurance and will provide a Special Enrollment Period (SEP) for individuals and families to apply and enroll in the coverage they need.”

The SEP applies to the 36 states that use the federal healthcare.gov platform to operate their Health Insurance Marketplace. Fourteen states and the District of Columbia operate their own state-based Marketplace, and while they are not required to offer a similar SEP to their residents, many of them are expected to or have already announced that they will.

To learn which platform your state uses to operate their Marketplace, go to healthcare.gov and click on “Get Coverage” at the top of the page. Once on the Get Coverage page, select your state from the dropdown menu. If you see a button that says, “APPLY NOW,” your state uses the federal platform. If you see a button that says, “VISIT YOUR STATE MARKETPLACE,” your state operates their own Marketplace.

When does the SEP start?

The SEP will start February 15, 2021 and continue through May 15, 2021.

Who can sign up for coverage during the SEP?

If you are eligible for the Marketplace and are currently uninsured, the SEP will be open to you to submit a new application for coverage.

If you are currently enrolled in an ACA Marketplace plan but want to update your existing application, the SEP will also be open to you. You will have to go through your existing application, submit any changes to your information and receive an updated eligibility determination to claim the SEP. You would then be able to choose any available plan in your area, without restriction to the same level of coverage as your current plan.

If I am eligible for coverage and enroll in a plan, when would my coverage start?

You will have 30 days after you submit your application to choose a plan, and coverage will start the first of the month after your plan selection.

How does this new SEP differ from other SEPs?

Typically, a SEP is only available if you have experienced certain qualifying events, such as if you lose health coverage, move, get married, have a baby or adopt a child. Depending on the SEP type, you may have 60 days before or after a qualifying event to enroll in a plan. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time of year if eligible, regardless of whether you qualify for a SEP.

The new SEP will be broader and open to Marketplace-eligible people who do not otherwise qualify for a SEP based on a qualifying event. It will also be open to current Marketplace enrollees who are looking to switch plans. The new SEP will not require you to answer any new application questions or provide any new information not otherwise required to determine eligibility to enroll in coverage. You will also not need to provide any documentation of a qualifying event.

Where can I find more information? How do I sign up for coverage or change an existing application?

Starting February 15, you can access the SEP through healthcare.gov or the Marketplace call center, 1-800-318-2596. TTY users should call 1-855-889-4325. You can also find local help by going to localhelp.healthcare.gov .

If your state does not use the federal platform to operate their Marketplace, you can contact your state’s Marketplace for more information. You can navigate to the official website for your state’s Marketplace to find their contact information by clicking on the “VISIT YOUR STATE MARKETPLACE” button as described above.

Posted:

About the Author

Mike Ly

Mike Ly is the director of public policy at the American Kidney Fund.

Become an Advocate