Even though Open Enrollment Year 9 (OE9) has ended, there could be still ways to enroll. Generally, if someone experiences a major life event, they could qualify for a Special Enrollment Period (SEP). (You can read more about what qualifies for a SEP as a result of a major life event in this blog post.)
However, thanks to a new SEP coverage could be available for lower-income consumers which could qualify them to enroll in Marketplace coverage. This coverage would allow people to enroll who have an estimated annual household income at or lower than 150% the Federal Poverty Level (FPL) and are eligible for Advanced Premium Tax Credits (APTC). The FPL varies based on the size of the household. To determine the FPL for a household check out these guidelines from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to assess their eligibility. For example, 150% of FPL is generally $19,320 for a household of 1 and $39,750 for a household of 4. For a handy chart on FPL, you can also check out this resource from the Center on Budget and Policy Priorities.
Potential enrollees also need to be eligible to receive APTC. For instance, individuals who are not eligible to receive APTC are the following:
- Individuals who can be claimed as a dependent by someone on their tax return;
- Individuals who have an offer of affordable coverage through their work; or
- Individuals who have access to coverage through programs like Medicaid, Medicare, CHIP or TRICARE.
Initially, enrollment will not happen automatically when applying as HealthCare.gov will need to follow up with enrollees by phone and email to approve enrollment. CMS indicates this should happen within a week. As CMS is still implementing this, they anticipate that around March 18 the system should allow for individuals who qualify to automatically enroll through healthcare.gov without needing to be contacted.
Health care disparities greatly affect people with disabilities, with access to health care services and coverage being at the forefront of this issue. Since access to healthcare is typically linked with income status, coverage for those in marginalized groups often comes with many hurdles and AAHD hopes that this new SEP could make it easier for people with disabilities to enroll in coverage if they need it.
For more information, please contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for enrollment help or visit HealthCare.gov for more information.
