If your income does not exceed 150% of the federal poverty level, you now qualify for a Special Enrollment Period.
Starting late March 2022, agents can enroll eligible clients through the new 150% Federal Poverty Level (FPL) SEP category. For Marketplace coverage, eligibility is based on the previous year’s FPL chart.
This new Special Enrollment Period was created to make it easier for low-income Americans to enroll in marketplace coverage throughout the year and not just during open enrollment or when they experience a qualifying life event.
What are the Eligibility Criteria?
Eligible applicants can enroll in an ACA-compliant health plan through the marketplace year-round if:
- An applicant’s household income does not exceed 150% of the federal poverty level (FPL)
- If the applicant is eligible for a premium tax credit (subsidy).
This special enrollment period does not have limitations on how often it can be used, or the type of health plan that can be selected. But people with income up to 150% of the federal poverty level are strongly encouraged to select a Silver plan, which has built-in Cost-Sharing Reductions that make the coverage better than a Platinum plan.
Medicaid-eligible individuals or individuals in the Medicaid Gap are not eligible for this SEP.
For Applicants with Existing Coverage
An applicant with an eligible household income who is already enrolled in an exchange plan can use this SEP to pick a different plan, although deductible and out-of-pocket spending would reset to $0 for the year when the new plan starts.
However, the new rules do clarify that if a current applicant is adding a dependent to their plan:
- They can either add the dependent to the existing plan.
- Or switch to a Silver level plan and enroll the new dependent in that plan.
But the SEP cannot be used to switch the current enrollee to a non-Silver plan together with the new dependent.
Through this SEP, new clients who fit this eligibility can enroll in a Marketplace plan and existing clients could change their plan. If an existing client chooses to change their plan, their deductible and out of pocket max will reset.
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.
