Jan 28, 2021
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
eligibility 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 eligibility.
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/
https://www.cms.gov/newsroom/fact-sheets/2021-special-enrollment-period-response-covid-19-emergency
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