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The
coronavirus disease 2019 (COVID-19) national emergency has presented
unprecedented challenges for the American public. Millions of
Americans are facing uncertainty and millions of Americans are experiencing
new health problems during the pandemic. Due to the exceptional
circumstances and rapidly changing Public Health Emergency (PHE) impacting
millions of people throughout the US every day, many Americans remain
uninsured or underinsured and still need affordable health coverage. In
accordance with the Executive Order issued today by President Biden, the
Centers for Medicare & Medicaid Services (CMS) determined that the
COVID-19 emergency presents exceptional circumstances for consumers in
accessing health insurance and will provide a Special Enrollment Period
(SEP) for individuals and families to apply and enroll in the coverage they
need. This SEP will be available to consumers in the 36 states served by
Marketplaces that use the HealthCare.gov platform, and CMS will conduct
outreach activities to encourage those who are eligible to enroll in health
coverage. CMS strongly encourages states operating their own Marketplace
platforms to make a similar enrollment opportunity available to consumers
in their states.
Starting
on February 15, 2021 and continuing through May 15, 2021, Marketplaces
using the HealthCare.gov platform will operationalize functionality to make
a SEP available to all Marketplace-eligible consumers who are submitting a
new application or updating an existing application. These consumers will
newly be able to access the SEP through a variety of channels: through
HealthCare.gov directly, the Marketplace call center, or direct enrollment
channels. Additionally, consumers can work with a network of over
50,000 agents and brokers who are registered with the Marketplace, along
with over 8,000 trained assisters, ready to assist consumers with their
application for coverage.
To
promote the SEP and ensure that a broad and diverse range of consumers are
aware of this implementation, CMS will conduct an outreach campaign in
cooperation with community and stakeholder organizations, focused on
education and awareness of this new opportunity to enroll in English,
Spanish and other languages. CMS outreach efforts will use a mix of
paid advertising and direct outreach to consumers. Outreach efforts will
include considerable awareness building efforts to encourage the uninsured
and those who come to HealthCare.gov to explore coverage to continue the
process and enroll. CMS plans to spend $50 million on outreach and
education, on a mix of tactics to increase awareness, including
advertisements on broadcast, digital, and an earned media.
Some
consumers may already be eligible for other existing SEPs, Medicaid, or the
Children’s Health Insurance Program (CHIP) – they can visit HealthCare.gov now
to find out if they can enroll even before this new SEP. Starting
February 15, consumers seeking to take advantage of this SEP can find out
if they are eligible by visiting HealthCare.gov, and
are no longer limited to calling the Marketplace call center to access this
SEP. 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. Consumers will have 30 days after
they submit their application to choose a plan. 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 step through their
application and make any changes if needed to their current information and
submit their application in order to receive an updated eligibilty result
that provides the SEP before continuing on to enrollment. This 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. In
addition, consumers won’t need to provide any documentation of a qualifying
event (e.g., loss of a job or birth of a child), which is typically
required for SEP eligiblity.
As
always, consumers found eligible for Medicaid or CHIP will be transferred
to their state Medicaid and CHIP agencies for enrollment in those programs.
For
more information about the Health Insurance Marketplace®[1], visit: https://www.healthcare.gov/quick-guide/getting-marketplace-health-insurance/
To view a
press release about this announcement, visit: https://www.hhs.gov/about/news/2021/01/28/hhs-announces-marketplace-special-enrollment-period-for-covid-19-public-health-emergency.html
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[1] Health Insurance Marketplace®
is a registered service mark of the U.S. Department of Health & Human
Services
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