A recent change to the application on healthcare.gov allows for additional time to complete enrollment as a result of a Special Enrollment Period (SEP) due to the COVID-19 pandemic which has resulted in a national disaster emergency. Our partners at the Center on Budget and Policy Priorities summarized this FEMA SEP in an email as part of their “Health Reform: Beyond the Basics” project. That summary is provided here:
The FEMA SEP gives people extra time to enroll if (1) they reside in an area during the incident period of a FEMA-declared disaster or emergency (currently, all states are covered under the COVID-19 pandemic national emergency declaration); (2) they were eligible for another SEP; and (3) they failed to enroll with the SEP for which they were eligible due to impacts from the FEMA-declared disaster (in this case, impacts from COVID-19).
This means that if someone was eligible for a SEP at some point this year but didn’t enroll, they may still qualify for coverage.
If the applicant was eligible for an SEP other than for loss of coverage (for example, birth of a child or a change of permanent residence), but failed to enroll due to the impacts of COVID-19, they are still eligible for the FEMA SEP but will need to contact the Marketplace call center for help.
Note that people who haven’t had any SEP-qualifying events since January 1 are not eligible for the FEMA SEP.
The HealthCare.gov application has implemented this change for people who’ve lost any type of qualifying coverage. Instead of asking whether an applicant has lost coverage within the last 60 days, the application now asks whether they’ve lost coverage since January 1. The applicant will still need to prove that they’ve lost coverage. If the applicant was eligible for an SEP other than for loss of coverage (for example, birth of a child or a change of permanent residence), but due to the impacts of COVID-19, failed to enroll during that SEP, they are still eligible for the FEMA SEP but will need to contact the Marketplace call center for help.
The default coverage effective date for the FEMA SEP is the first day of the month following plan selection. However, a consumer can contact the Marketplace call center to request a retroactive effective date; the earliest effective date is the first day of the month following the qualifying event for the original SEP and the FEMA-designated incident start date.
