2024 Pay or Play Affordability Percentage

New Exchange Special Enrollment Period Available

In response to the executive actions recently signed by President Biden, the Centers for Medicare & Medicaid Services (CMS) announced a new Special Enrollment Period (SEP) through Exchanges using the federal www.HealthCare.gov platform. The CMS determined that the COVID-19 emergency has and continues to present exceptional challenges and circumstances for consumers in accessing health insurance, ultimately prompting the agency to provide such an opportunity.

Starting on February 15, 2021, and continuing through May 15, 2021, Exchanges using the www.HealthCare.gov platform will operationalize functionality to make an SEP available to all Exchange-eligible consumers who are submitting a new application or updating an existing application.

Consumers seeking to take advantage of this SEP can find out if they are eligible to enroll by visiting www.HealthCare.gov, and are no longer limited to calling the Marketplace call center to access an SEP. Once an application is submitted, consumers will have 30 days to choose a plan that fits their needs.

  • Consumers who are eligible and enroll under this SEP will be able to select a plan with coverage that starts prospectively the first of the month after plan selection.
  • Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan.

In order to use this SEP, current enrollees will need to use their existing application, making any necessary changes, to receive an updated eligibility result that provides the SEP before continuing on to enrollment. The new SEP opportunity will not involve any new application questions or require consumers or enrollment partners to provide any new information not otherwise required to determine eligibility and enroll in coverage. Additionally, consumers will not need to provide any documentation that proves a qualifying event (i.e. loss of a job, marriage or birth of a child).

To promote the SEP and ensure consumer awareness of this implementation, CMS will conduct an outreach campaign in cooperation with community and stakeholder organizations. The campaign will focus on the education of this special enrollment opportunity and ability to enroll in English, Spanish and other languages. States using their own Exchange platforms are encouraged to make a similar SEP available for eligible consumers.

For additional information, click here.

The Creative Benefits Inc. team is here to assist and keep you updated on pertinent information. Questions? Contact us at 866-306-0200 or solutions@creativebenefitsinc.com.