There is a new special enrollment period (SEP) available starting in March 2022 that makes it easy for people with low income to enroll in a marketplace plan outside of open enrollment.
What is an SEP?
An SEP is a Special Enrollment Period. If you miss Open Enrollment, certain events allow you to apply and enroll in a Marketplace plan outside of Open Enrollment. These events include; marriage, divorce, the birth of a child, losing employer or another insurance, moving to another state, or death in the family. Read more about SEPs- What Are Special Enrollment Periods? and Special Enrollment Periods-healthcare.gov
What is the new SEP for low-income people?
If your projected income is at or below 150% of the Federal Poverty Limit and you are eligible for tax credits, you qualify for the SEP. If your income is below 150% of the FPL and you are not eligible for Medicaid, you can enroll in any month of the year without a qualifying life event. Your income qualifies you for the SEP.
New Marketplace SEP 150% of Federal Poverty Level (2021 level)
| Household Size 1 = $19, 320 | Household Size 4 = $39,750 |
| Household Size 2 = $26,130 | Household Size 5 = $46,560 |
| Household Size 3 = $32,940 | Household Size 4 = $53,370 |
Who is eligible for the SEP?
To qualify, a person must:
- Be eligible for tax credits based on the normal eligibility rules.
- Have an annual projected income that is at or below 150% FPL.
- Not have an offer of affordable employer insurance.
The normal rules for tax credits apply. If you are eligible for affordable employer insurance or Medicaid, you are not eligible for this SEP.
When is the SEP available? And should I apply? Yes!
This SEP is available now. The SEP is automatically approved by submitting a HealthCare.gov application. The marketplace is reviewing applications submitted since the end of Open Enrollment (January 15, 2022) and will reach out by email or phone to approve the SEP. If you think you are eligible, submit an application at healthcare.gov or call the marketplace and apply. 1-800-318-2596
When will coverage begin?
Coverage begins the first day of the month following plan selection, no matter which day during the month the person applied.
Can I switch plans if I qualify for this SE
Yes, but there are restrictions. A current enrollee with up to a 150% FPL projected income can switch to a silver plan, or if they are already enrolled in a silver plan, to a different silver plan. There is no switching to another plan tier, like bronze or gold. Enrollees can switch multiple times a year.
Remember switching from one company’s silver plan to another will reset deductibles and out-of-pocket maximums. Be careful!
What proof or documentation do I need to get this SEP?
People can attest to their projected annual income. The marketplace will not require pre-enrollment documentation but it will do the normal post-enrollment verification process. The marketplace will attempt to verify income using electronic data sources (for example, last year’s tax return). If unable to verify, the marketplace will ask for other verification- recent pay stubs, letters from employer or accountant, client letter stating projected income, or other acceptable documentation.
How long is this SEP available?
This SEP is only available as long as the increased tax credits from the American Rescue Plan are available. Right now, they are set to expire at the end of 2022. Congress would need to pass a bill to extend the increase and the SEP.
As always, if you need assistance or have questions, please contact us.
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This blog post is an edited version of this incredibly helpful FAQ New Low-Income Special Enrollment Period flyer from the Health Reform Beyond the Basics project from the Center on Budget and Policy Priorities.