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New SEP Offered Year-Round for Low Income Individuals



 

Beginning in 2022, Healthcare.gov will allow enrollment throughout the entirety of the year for any individual falling at or below the 150% Federal Poverty Level (FPL).


What can beneficiaries do under this new enrollment period?

In this new special enrollment period, applicants can enroll any time of the year, with their coverage taking effect the first day of the following month. 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. Though those applying are strongly encouraged to enroll in a silver plan, as silver plans have built-in cost-sharing reductions, making them a better value than platinum plan offerings.

The two lowest-cost silver plans also offer $0 premiums for those applying up to 150% of the FPL. If a beneficiary is already enrolled in an exchange plan, as long as they fall under the 150% FPL mark, they can use the SEP to switch to a new plan, keeping in mind that the deductible and max-out-of-pocket would reset upon switching.

If a current enrollee wants to add a dependent to their plan, they can either add the dependent to their current plan or switch to a silver plan and add the dependent, what they CAN'T do, is switch from the silver plan to a non-silver plan and add the dependent.

Who is eligible to enroll using this SEP?

As mentioned already, any applicant with an income at or below 150% of the Federal Poverty Level is eligible to enroll in this SEP.

For context, 150% FPL equates to:

$19,320 for a single individual

$26,130 for a household of 2

$ 32,940 for a household of 3


To be eligible, applicants must also:

  1. Be eligible for premium tax credits

  2. Not eligible for Medicaid or Free-premium Medicare Part A

  3. Not eligible for an employer-sponsored health plan that is considered affordable

How is eligibility proven?

The applicant must only attest to a certain income level at or below the 150% FPL mark. If the client's claimed projected income amount does not match what the government has on file, proof of income would be required for approval.

Additional key points to keep in mind

Some other important details to keep in mind regarding the special enrollment period are listed below.

  • States with their own exchanges are not required to offer this SEP, therefore making it unavailable to applicants in those states which decide not to make it available

  • Most applicants are eligible for Medicaid with income levels up to 138% FPL (100% for non-expanded Medicaid states). Therefore a more accurate income range of eligible applicants is 138%(100%)- 150% FPL

  • However, recent immigrants who are not eligible for Medicaid would be eligible with income from 0% to 150% FPL

  • Applicants receiving unemployment are currently eligible, as income is determined to be 133% FPL for those receiving unemployment, regardless of actual income

 

If you have any questions about these updates, you can find support by calling the Keystone Agent support line at (346) -233-1992.


If you aren't yet an agent with Keystone Advisors, you can complete an onboarding form at keystoneadvisorsproduceracademy.com/partnerwithkeystoneadvisors

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