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Health Insurance Marketplace Special Enrollment Periods in the Federally- facilitated Marketplace March 2015.

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Presentation on theme: "Health Insurance Marketplace Special Enrollment Periods in the Federally- facilitated Marketplace March 2015."— Presentation transcript:

1 Health Insurance Marketplace Special Enrollment Periods in the Federally- facilitated Marketplace March 2015

2  Annual Open Enrollment Period (OEP) The OEP for coverage in 2015 ended February 15 For coverage in 2016, the OEP will be November 1-January 31  During a Special Enrollment Period (SEP), if eligible  Once per month if member of federally recognized Indian tribe or Alaska native shareholder When You Can Enroll in Coverage March 2015Marketplace Special Enrollment Periods2

3  Outside Open Enrollment, you can enroll if you’re eligible for an SEP because you have A qualifying life change, or Another qualifying circumstance  Most SEPs last 60 days from the date of the qualifying event 30 days in the Small Business Health Options Program (SHOP) Marketplace Special Enrollment Periods (SEPs) March 2015Marketplace Special Enrollment Periods3

4  You may obtain a SEP to enroll in 2015 coverage if you Aren’t currently enrolled in coverage through the Health Insurance Marketplace for 2015, Were subject to owe the fee on your 2014 federal income tax return for not having health coverage in 2014, and Attest that you were unaware of, or didn't understand, the ACA requirement to maintain minimum essential coverage until after February 15, 2015 (the end of the 2015 Open Enrollment Period) This Special Enrollment Period will start on March 15 and end at 11:59 pm E.S.T. on April 30, Limited Special Enrollment Period for Tax Season–Federally-facilitated Marketplace March 2015Marketplace Special Enrollment Periods4

5 Life Changes That May Qualify You For a Special Enrollment Period  Getting married  Having a baby  Adopting a child or placing a child for adoption or foster care  Losing other health coverage (minimum essential coverage) due to Resigning, getting laid off, or getting fired Divorce (see slide 7) COBRA coverage ending (but not cancelling it yourself before it expires) Aging off a parent’s plan when you turn 26 Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) Continued on next slide March 2015Marketplace Special Enrollment Periods5

6 Life Changes That May Qualify You For a Special Enrollment Period (Continued) March 2015Marketplace Special Enrollment Periods6  Permanently moving outside your plan’s coverage area  Gaining citizenship or lawful presence in the U.S.  Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder  Leaving incarceration  For people already enrolled in Marketplace coverage Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

7  Divorce and legal separation can change your Marketplace coverage options You may lose coverage if you were enrolled through a spouse/partner who removes you from coverage You may no longer need to keep a spouse or partner on your plan due to divorce or separation  You can qualify for an SEP once the divorce or separation is legally finalized Divorce/Legal Separation Life Changes March 2015Marketplace Special Enrollment Periods7

8 How to Use a Special Enrollment Period for a Life Change  If you have a qualifying life change, you can contact the Marketplace Online at HealthCare.gov  Log into your account and click on Report a life change By phone  Call the Marketplace Call Center at  TTY March 2015Marketplace Special Enrollment Periods8

9 Online at HealthCare.gov/screener Use the screening tool to see if you qualify for a Special Enrollment Period Maricopa County March 2015Marketplace Special Enrollment Periods9

10 Answer a Few Questions about Life Changes March 2015Marketplace Special Enrollment Periods10

11 Start or Update an Application If it looks like you may qualify, update your old application if you have one, or start a new one if you don’t March 2015Marketplace Special Enrollment Periods11

12 Gather Important Information Download or print this checklist so you know what information may be needed to apply for coverage marketplace.cms.gov/outreach -and-education/apply-for-or- renew-coverage.pdf March 2015Marketplace Special Enrollment Periods12

13 Type of Life Change SEPPlan Selection DateCoverage Effective Date 1.Move to a new service area 2.Release from incarceration 3.Become lawfully present 4.Gain status as an Indian Between the 1 st and 15 th day of the month First day of the following month Between the 16 th and last day of the month First day of the second following month Loss of minimum essential coverage (MEC) Any day of the monthFirst day of the following month Future loss of MEC (up to 60 days in the future) Any day of the monthFirst day of the month following loss of MEC Gaining a dependent through marriage Any day of the monthFirst day of the following month Birth, adoption, or placement for adoption or foster care Any day of the monthDay the child was born, adopted, or placed for adoption or foster care Coverage Effective Dates for Life Change SEPs March 2015Marketplace Special Enrollment Periods13

14  You may be eligible for an SEP if you experienced other qualifying circumstances during Open Enrollment Enrollment errors Exceptional circumstances Misinformation, misrepresentation, or inaction Specific system issues Having current COBRA coverage Individual market plan renewal outside of Open Enrollment Members of AmeriCorps, VISTA, and NCCC programs Types of Special Enrollment Periods - Other Qualifying Circumstances March 2015Marketplace Special Enrollment Periods14

15  You chose a plan by the deadline, but Enrollment wasn’t processed by the Marketplace Insurer doesn’t have the enrollment, or You were enrolled in the wrong plan  Examples of enrollment errors Missing enrollment records Defective enrollments Enrollment Errors March 2015Marketplace Special Enrollment Periods15

16  Serious situations that prevent you from enrolling by the appropriate deadline Medical emergency Natural disaster Planned system outage  Must submit documentation of medical emergency or natural disaster Exceptional Circumstances March 2015Marketplace Special Enrollment Periods16

17  Misconduct by a non-Marketplace entity that caused you To not be enrolled in a plan To be enrolled in the wrong plan To not get lower costs for which you’re eligible  Non-Marketplace entity may be an insurer, Navigator, certified application counselor, agent or broker Misinformation, Misrepresentation, or Inaction March 2015Marketplace Special Enrollment Periods17

18 1.Call the Marketplace Call Center to request an SEP at (TTY ) 2.Call Center asks questions to determine if you’re eligible 3.If granted, the Call Center activates the SEP 4.You can enroll online or through the Call Center 5.If your SEP request is denied, you can appeal General Process for Other Circumstance Special Enrollment Periods (SEPs) March 2015Marketplace Special Enrollment Periods18

19  Generally you have 60 days to select a plan From date you’re granted Other Circumstance SEP  Plan selection timeframe starts when You get a letter telling you you’re eligible for an SEP You contact the Call Center and are found eligible A Caseworker finds you eligible  Coverage effective dates generally follow regular effective date guidelines Plan Selection for Other Circumstance Special Enrollment Periods (SEPs) March 2015Marketplace Special Enrollment Periods19

20 Requesting a Marketplace Eligibility Appeal  Two ways to request a Marketplace eligibility appeal 1. Complete an appeal request form  Available at HealthCare.gov/can-i-appeal-a-marketplace-decision/ 2. Write a letter explaining the reason for the appeal  Then mail the request to Health Insurance Marketplace 465 Industrial Blvd. London, KY /28/2015Marketplace Eligibility Appeals20

21  You can request an appeal within 90 days of receiving an eligibility determination  You can get help with Marketplace eligibility appeals Health Insurance Marketplace Call Center- will help by explaining how to request an appeal  (TTY: )  The Marketplace Appeals Center can answer questions about your appeal after it is filed Call (TTY: ) Getting Help With Appeals 01/28/2015Marketplace Eligibility Appeals21

22  Navigator program‒can help you ask for a Marketplace eligibility appeal  Appointed representatives‒can request a Marketplace eligibility appeal and speak for the you Call the Marketplace Appeals Center to learn more (TTY: ) Getting Help With Appeals (Continued) 01/28/2015Marketplace Eligibility Appeals22

23 This training module is provided by the CMS National Training Program (NTP) For questions about training products To view all available NTP materials, or to subscribe to our list, visit cms.gov/outreach-and- education/training/cmsnationaltrainingprogram/. cms.gov/outreach-and- education/training/cmsnationaltrainingprogram/


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