Do You Qualify for the Marketplace Special Enrollment Period?

If you missed the open enrollment period for ACA healthcare coverage, you may still have a chance to enroll in an ACA-compliant healthcare plan in the marketplace. The U.S. Department of Health & Human Services has announced a special enrollment period for individuals at or below the federal poverty level (FPL).

What the new special enrollment period means for eligible applicants

If you qualify for this special enrollment period, it means that you can enroll in ACA-compliant healthcare plans at any point during the year. When you enroll, the coverage for your plan begins on the first day of the next month. There is no limit to how often you can use the special enrollment period, and you can use it to enroll in any plan. This special enrollment period is set to begin in late March.

If you’re already enrolled in a plan, you can use the special enrollment period to switch to a different plan. Be aware though, that switching plans will reset your deductible and out-of-pocket spending to $0 once your new plan starts the following month. You can also use the special enrollment period to add a new dependent to your existing plan.

Are you eligible for the special enrollment period?

There are two requirements for eligibility in this special enrollment period:

·       You must be at or below 150% of the federal poverty level in your state. The federal poverty level depends on the state you live in and the size of your household. You can use this calculator to determine if you are at or below 150% of the federal poverty level in your state and for your household.

·       You also must be eligible for premium tax credits. This means that no matter your income, you are only eligible for the special enrollment period if you are not eligible for Medicaid, premium-free Medicare Part A, or an employer-sponsored healthcare plan that is considered affordable and provides you with minimum value.

If you are eligible, you could get the benchmark healthcare plan without paying a premium.

More important information about this special enrollment period

·       People who recently immigrated to the United States and are not eligible for Medicaid due to their new immigrant status will be able to qualify if their income is below 150% of the federal poverty level.

·       In many states where Medicaid has been expanded, the eligibility window for this special enrollment period is more narrow, from 139% to 150% of the federal poverty level. This is due to these states expanding Medicaid to be available to those with income up to 138% of the federal poverty level.

Wilfinger Health + Life | Healthcare plans & help with special enrollment period

If this information felt overwhelming, you are not alone. Insurance can often be confusing, especially in unusual circumstances like this coming special enrollment period. If you have any questions about your eligibility or how to prove that you qualify for this special enrollment period so that you can get healthcare coverage when the time comes, please ask me help. I would love to walk you through the process and help you get the healthcare you deserve.

For any healthcare and life insurance related questions, please give me a call at (586) 604-7632 or send in an online contact form to get the answers you need.