SEP for less than 150% FPL??

[yankee466]

Can anyone confirm or deny what I am reading on the internet that for 2022, thanks to the American Recovery Act, if your income is below 150% FPL, and not Medicaid eligible, that you have a year long SEP on the Federal Marketplace to buy insurance and/or change plans? The idea is to help the most under-privileged among us to get insurance as needed...and likely vote Democratic at the same time.

There is no mention of it on HC.gov, yet the internet seems to confirm it with fairly reliable web sites. HC.gov broker support never heard of it

CMS.gov shows the following:

Monthly Special Enrollment Period (SEP) for Advance Payments of Premium Tax Credits (APTC)-Eligible Consumers with Household Income up to 150% of the Federal Poverty Level (FPL) whose Applicable Taxpayer has an Applicable Percentage of Zero

To provide more opportunities for certain low-income consumers to access coverage with low or no premiums after APTC, such as under the American Rescue Plan (ARP), Marketplaces will now have the option to provide a monthly SEP for APTC-eligible consumers with a projected annual household income no greater than 150% of the FPL. The rule will permit Marketplaces to provide a SEP for periods of time during which premium tax credits are available without the applicable taxpayer having to contribute toward their applicable portion of premiums before premium tax credits become available, such as those currently available under section 9661 of the ARP. Marketplaces on the federal platform will implement this SEP by providing eligible consumers with a pathway through the HealthCare.gov application during such periods of time.

very odd....either a well guarded secret or fake news.....thanks

 

[Yagents]

Can anyone confirm or deny what I am reading on the internet that for 2022, thanks to the American Recovery Act, if your income is below 150% FPL, and not Medicaid eligible, that you have a year long SEP on the Federal Marketplace to buy insurance and/or change plans? The idea is to help the most under-privileged among us to get insurance as needed...and likely vote Democratic at the same time.

There is no mention of it on HC.gov, yet the internet seems to confirm it with fairly reliable web sites. HC.gov broker support never heard of it

CMS.gov shows the following:

Monthly Special Enrollment Period (SEP) for Advance Payments of Premium Tax Credits (APTC)-Eligible Consumers with Household Income up to 150% of the Federal Poverty Level (FPL) whose Applicable Taxpayer has an Applicable Percentage of Zero

To provide more opportunities for certain low-income consumers to access coverage with low or no premiums after APTC, such as under the American Rescue Plan (ARP), Marketplaces will now have the option to provide a monthly SEP for APTC-eligible consumers with a projected annual household income no greater than 150% of the FPL. The rule will permit Marketplaces to provide a SEP for periods of time during which premium tax credits are available without the applicable taxpayer having to contribute toward their applicable portion of premiums before premium tax credits become available, such as those currently available under section 9661 of the ARP. Marketplaces on the federal platform will implement this SEP by providing eligible consumers with a pathway through the HealthCare.gov application during such periods of time.

very odd....either a well guarded secret or fake news.....thanks

It is true, but of course the marketplace is not ready for these enrollments. Sherpa has a note on it if you log in.

The SEP will be for 100 to 150% FPL in non medicaid expansion states. Under 100% are not eligible.

In medicaid expansion states its 139 to 150 % who are eligible

 

[Yagents]

Can anyone confirm or deny what I am reading on the internet that for 2022, thanks to the American Recovery Act, if your income is below 150% FPL, and not Medicaid eligible, that you have a year long SEP on the Federal Marketplace to buy insurance and/or change plans? The idea is to help the most under-privileged among us to get insurance as needed...and likely vote Democratic at the same time.

There is no mention of it on HC.gov, yet the internet seems to confirm it with fairly reliable web sites. HC.gov broker support never heard of it

CMS.gov shows the following:

Monthly Special Enrollment Period (SEP) for Advance Payments of Premium Tax Credits (APTC)-Eligible Consumers with Household Income up to 150% of the Federal Poverty Level (FPL) whose Applicable Taxpayer has an Applicable Percentage of Zero

To provide more opportunities for certain low-income consumers to access coverage with low or no premiums after APTC, such as under the American Rescue Plan (ARP), Marketplaces will now have the option to provide a monthly SEP for APTC-eligible consumers with a projected annual household income no greater than 150% of the FPL. The rule will permit Marketplaces to provide a SEP for periods of time during which premium tax credits are available without the applicable taxpayer having to contribute toward their applicable portion of premiums before premium tax credits become available, such as those currently available under section 9661 of the ARP. Marketplaces on the federal platform will implement this SEP by providing eligible consumers with a pathway through the HealthCare.gov application during such periods of time.

very odd....either a well guarded secret or fake news.....thanks

Note from Sherpa:
SEP for Consumers ≤150% FPL
The new SEP for consumers ≤150% FPL has not yet been operationalized on HC.gov or EDE partners. We will share information on timing as soon as it's available. For more information on the new SEP, click here.

Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule | CMS

 

[yankee466]

Training on the new <150% SEP is being set up as we speak.....so this is likely to go live soon. It should basically work as if "denied Medicaid coverage", although I would expect there is an income table to bounce against to award the SEP.

Last I saw was late March implementation.

I can see a lot of people suddenly needing insurance claim to be low income.. The insurance carriers should love this.

 

[yankee466]

Well...I attended what I felt was a poorly run educational session on this new option by marketplace folk who should have been either more prepared or at least a little more knowledgeable of their own systems and plans. I felt I knew more than they did simply by reading the annoucement.

What I came away with., or my understanding anyway...

• You can enroll someone now who is 100%-150% FPL by working with a market-place call center person....either three way with client., or permission on their ap. The person MUST be subsidy eligible to qualify....so it does not change the rules for states that have NOT expanded Medicare..ie, you have to be poor, not broke.
• Later in March, you will have the additional SEP option on both HC.gov and Sherpa/etc to allow a normal enrollment without marketplace call center involved...which of course is far less painful.. No one knew if there was any income verification required.
• It was assumed that this SEP would also allow someone to change an exsisting ACA plan...but no one on the call could answer for sure.
• There is no 15th of the month rule...so it would be always be effective on the first day of the immediate following month.
• You are free to increase the projected income later in the year, with only normal impact on subsidies, etc (hint, hint, wink, wink)

I guess time will tell.

 

[Yagents]

Well...I attended what I felt was a poorly run educational session on this new option by marketplace folk who should have been either more prepared or at least a little more knowledgeable of their own systems and plans. I felt I knew more than they did simply by reading the annoucement.

What I came away with., or my understanding anyway...

• You can enroll someone now who is 100%-150% FPL by working with a market-place call center person....either three way with client., or permission on their ap. The person MUST be subsidy eligible to qualify....so it does not change the rules for states that have NOT expanded Medicare..ie, you have to be poor, not broke.
• Later in March, you will have the additional SEP option on both HC.gov and Sherpa/etc to allow a normal enrollment without marketplace call center involved...which of course is far less painful.. No one knew if there was any income verification required.
• It was assumed that this SEP would also allow someone to change an exsisting ACA plan...but no one on the call could answer for sure.
• There is no 15th of the month rule...so it would be always be effective on the first day of the immediate following month.
• You are free to increase the projected income later in the year, with only normal impact on subsidies, etc (hint, hint, wink, wink)

I guess time will tell.

Thanks for the update. I gave up after the call didn't start after 20 minutes. What a disaster coming. Consumers are too stupid to know about this loophole, and only fraudulent agents will take advantage of it.

 

[yankee466]

And so it begins......The new feature is live......need expensive surgery? Don't have insurance? Tell them you are low income in a state without Medicaid expansion like Georgia, and you are good to go with free insurance. I am sure the carriers love this new SEP.

 

[myinsurebiz]

So, what would the income thresholds be for GA and SC, which didn't expand medicaid?

 

[yankee466]

So, what would the income thresholds be for GA and SC, which didn't expand medicaid?

Between 100-150% FPL

 

[myinsurebiz]

Between 100-150% FPL

Is that for a single man, a married couple, a family of 6?