With the close of the tax penalty special enrollment period (SEP) yesterday, it’s time to look at what other SEPs are available for consumers. One of the newest SEPs announced is for consumers in states that haven’t expanded Medicaid. If a consumer is below 100% of the Federal Poverty Level (FPL), then they are not eligible for premium tax credits (PTC). If during the course of the year their income rose to the point that they would now be eligible for the PTC and the change in income occurred outside of open enrollment, then before they were out-of-luck. Now these consumers are eligible for an SEP once their income goes above 100% of the FPL. Another new SEP announced is for consumers who gain a dependent as the result of a child support order. These SEPs were finalized as part of the recently finalized “Notice of Benefit and Payment Parameters” published by CMS. This notice can be accessed by clicking here.
The easiest way to qualify for an SEP is due to a qualifying life event. These could include: losing health coverage, getting married, having a baby and moving. A complete list of these life events can be found here. Last week’s news item on the close of the tax penalty SEP also had a link to the healthcare.gov screener tool to determine whether a consumer qualifies for an SEP. We also had a prior blog post last month which has links to some resources from the Georgetown University Center on Health Insurance Reforms. That blog post can be accessed here.
For a comprehensive look at SEPs, there is a new journal article from Health Affairs which addresses the number of people who could potentially be eligible for SEPs. The number is quite large which underlies the importance of continuing to do outreach even during non-open enrollment season. To access this article, click here.
Finally, it should be noted that there is no open enrollment for Medicaid and CHIP, so it’s never to late to sign up for coverage through those programs.