New Enrollment Period For Those Earning Below 150% Poverty Level

There will be a new Special Enrollment Period (SEP) in 2022 for consumers to enroll in Marketplace coverage. Applicants must earn 150% or less of the Federal Poverty Line to qualify. In order to determine eligibility, we use the previous year's FPL chart. 

Anyone who fits this eligibility can enroll in a Marketplace plan through this SEP, and those already enrolled can change plans through it. Changes to your plan will reset your deductible and out-of-pocket maximum if you are already enrolled.

What are the eligibility requirements for this SEP?

In most cases, consumers can apply for a plan twice a year:

• Open Enrollment Period generally runs from November 1 to January 15
• Special Enrollment Period, 1/16 - 10/31, when consumers can enroll in Marketplace plans after a Qualifying Life Event such as losing employer coverage, having a child, or moving.

If you meet both of these criteria, you may be eligible for this Special Enrollment Period:

• Have an estimated annual household income below 150% of the federal poverty level
• Get APTCs (Advanced Premium Tax Credits), which are subsidies for your monthly insurance premiums

Does this SEP not apply to everyone?

In order to use this SEP, consumers must be eligible for APTC (a subsidy applied to their monthly premium). As a result, they are not eligible for Medicaid or offered affordable employer-sponsored coverage. In addition, consumers who qualify for Medicaid subsidies in states that did not participate in Medicaid expansion cannot use this SEP; it does not affect their eligibility.

Currently, this SEP is available for Federally-facilitated Marketplaces (FFM) and all HealthSherpa plans. States that operate their own exchanges implement this SEP differently.

How do the effective date rules work?

The monthly SEP will follow accelerated effective date rules, which means consumers can enroll any day of the month and begin coverage the next month. When a consumer enrolls in a plan on 3/30/22, their coverage begins on 4/1/22.

If I receive this SEP, how will I know?

An applicant who qualifies for this SEP will see on their eligibility results page that they have received the grant "based on their projected household income of 150% of the federal poverty level".

Is this SEP going to last for a long time?

At the moment, this SEP is only valid for the calendar year 2022. In order to extend it, the American Rescue Plan (ARP) subsidy must also be extended. ARP subsidies make silver plans free for most consumers who qualify for this SEP.

‍