Good news for consumers! A fresh Special Enrollment Period (SEP) allows individuals who meet specific income criteria to enroll in Marketplace coverage for the rest of the 2022 calendar year.

Are You Eligible? If your household income is at or below 150% of the Federal Poverty Line, based on the prior year’s FPL chart, you might be. 

🔔 Important: This SEP allows qualified individuals to initiate enrollment into a Marketplace plan. Additionally, those already registered under a plan can consider switching. Do note that changing your plan might reset your deductible and out-of-pocket maximums.

When Can You Enroll? Under regular circumstances, there are two primary windows for enrollment:

1. The annual Open Enrollment Period, usually spanning 11/1 – 1/15.
2. The Special Enrollment Period, from 1/16 – 10/31, demands a Qualifying Life Event such as job loss, childbirth, or relocation for Marketplace plan enrollment.

For this unique SEP, your eligibility is anchored to these two conditions:

• Predicted annual household income at or below 150% FPL.
• Eligibility for Advanced Premium Tax Credits (APTC), a subsidy that alleviates your monthly premium costs.

💡 Did You Know? Individuals below the 100% FPL, ineligible for Medicaid due to immigration status, can still qualify for APTC and use this SEP, provided they meet all other Marketplace eligibility criteria.

Who Cannot Benefit from this SEP? This SEP is designed exclusively for those qualifying for APTC. Hence, if you’re eligible for Medicaid or have access to affordable employer-backed coverage, this SEP won’t apply. Additionally, individuals in the Medicaid Gap, primarily those earning less than 100% FPL in non-participating Medicaid expansion states, cannot utilize this SEP.

Where is this SEP Applicable? This SEP is recognized across the Federally-facilitated Marketplace (FFM) and all plans featured on HealthSherpa. Remember that its implementation might vary if you’re in a state with its exchange.

What About Enrollment Dates? Following accelerated effective date rules, you can enroll on any day, and your coverage commences from the subsequent month’s beginning. E.g., A 3/30/22 enrollment translates to coverage starting from 4/1/22.

How Do You Confirm Your SEP Eligibility? After the application process, if you qualify, you’ll notice the SEP entitlement “due to estimated household income (≤150% FPL)” on the outcome page.

SEP Duration? Currently, this SEP is restricted to the 2022 calendar year. Its extension relies on whether the American Rescue Plan (ARP) subsidies are prolonged. ARP subsidies allow most eligible consumers to access free silver plans through this SEP.

📞 Need Guidance or Further Information? Reach out to Plans for Life or dial 📞 915-591-1957. Ensure you’re making informed decisions about your health coverage!