How is the COVID SEP Different?

This past Monday was the start of the COVID Special Enrollment Period (SEP). Since the opening of the Affordable Care Act (ACA) marketplaces, there have always been SEPs. So how is this particular SEP different from any prior SEPs?

First of all, the COVID SEP comes as a direct result of the unprecedented public health crisis of the COVID-19 pandemic. As such, CMS wanted to ensure that anyone who is uninsured would be able to have access to coverage regardless of their life circumstances. Typical SEPs require a qualifying event for an individual to be eligible for a SEP. Examples of these types of qualifying events are loss of a job, getting married, having a baby or moving. The COVID SEP does not require any of these events to have occurred for an individual to be eligible for the SEP. Instead, the only factor which is considered is whether or not the person is uninsured. In other words, if you don’t have health insurance, you qualify for the COVID SEP. In this way, the COVID SEP operates more like another open enrollment period. In many ways, you can think of the COVID SEP as Open Enrollment 8.5.

Another difference with the COVID SEP is the time limitations. With a regular SEP, the individual has 60 days from the date of the qualifying event in order to enroll in a new plan. With the COVID SEP, an individual has until May 15, 2021 to complete enrollment on the ACA marketplace (healthcare.gov). Time differences also apply to when coverage becomes effective. Under the COVID SEP, coverage begins the next month regardless of how late in the month it is, so if someone enrolls in a plan on the last day of the month, the coverage would start the very next day.

Another difference between the COVID SEP and a traditional SEP is that no documentation is required for the COVID SEP as there is no reason to provide confirmation of a qualifying event.

To learn more about the COVID SEP, you can register for a webinar which CMS is hosting this afternoon at 3:00 PM ET. You can also read more about the COVID SEP in the FAQ sheet written by the Center for Budget and Policy Priorities. Finally, you can check out these prior blog posts and news items from our website:

In Cooperation

Contact Information