New enrollment period for those who make under 150% of the Federal Poverty Level
There is a new Special Enrollment Period (SEP) that enables qualifying consumers to enroll into a Marketplace coverage for the remainder of the 2022 calendar year. To qualify, the total household income must fall at or below 150% of the Federal Poverty Line. Eligibility is based on the previous year’s FPL chart. See chart below for reference.
Through this SEP, anyone who fit this eligibility can enroll in a Marketplace plan and those already enrolled in a plan can change their plan. If you are already enrolled in a plan and choose to change your plan, your deductible and out-of-pocket max will reset.
Who is eligible for this SEP?
Usually, consumers can apply for a plan at two times of the year:
- During the annual Open Enrollment Period, generally 11/1 – 1/15
- During the Special Enrollment Period, 1/16 – 10/31, where consumers typically need a Qualifying Life Event such as losing their employer coverage, having a child, or moving in order to enroll in a Marketplace plan.
During this Special Enrollment Period, you may be eligible if you fall in both of these criteria:
- Have an estimated annual household income at or below 150% FPL
- Are eligible for Advanced Premium Tax Credits (APTC)* which are a subsidy applied to your monthly premium
*As a reminder: Consumers with income below 100% FPL but who do not qualify for Medicaid due to immigration status only may still be eligible for APTC if they meet all other Marketplace eligibility requirements. They would also qualify to use this SEP.
Who is not eligible for this SEP?
Consumers must be eligible for APTC (a subsidy applied to your monthly premium) in order to use this SEP. That means they cannot be eligible for Medicaid or offered affordable employer-sponsored coverage. This also means consumers who fall into the Medicaid Gap (i.e. make less than 100% FPL in states that did not participate in Medicaid expansion) cannot use this SEP; nothing about this new SEP changes their eligibility for subsidies.
This SEP is live for the Federally-facilitated Marketplace (FFM) and all plans on HealthSherpa. Implementation of this SEP varies for states that operate their own exchange.
What are the effective date rules?
This monthly SEP will follow accelerated effective date rules, which means consumers can enroll any day of the month and have their coverage start the first day of the next month. For example, if a consumer enrolls in a plan on 3/30/22, their coverage will begin on 4/1/22.
How will I know if I have received this SEP?
After submitting an application, any qualifying applicant of this SEP will see that they have received the SEP “due to estimated household income (≤150% FPL)” on the eligibility results page.
How long will this SEP last?
For now, this SEP only exists for the 2022 calendar year. It will only be extended if the American Rescue Plan (ARP) subsidies are extended. With ARP subsidies, most consumers who are eligible for this SEP can enroll in free silver plans.
How do I know if I qualify for this SEP?
To see if you qualify, you can start a quote by entering in your zip code below.
Rough estimate for my personal annual income but I live with my mother at her residence and she carries me and my children on her taxes because we live with her.
I have a terrible insurance that is part welfare insurance and part medicare.
What is this insurance for? I imagine it is for my working neighbors that are so far below poverty level, I hope they don’t have to pay for it.
I know how hard it is I am supposed to be covered with dental but no dentist in my state took it and was left with around 4000.00 in dental bills. And have no money for utilities or prescription drugs.
What is this SE?
LisaSchumack
I have United Healthcare dual Complete and I have both Medicare and Medicaid.
How do.you have all.of that coverage?
I need health care….I’m collecting retirement & ssdi….and I’m 62 yrs old?
Go to healthsherpa.com or call us at (872) 228-2549
That sound like me but they drop me cause I move to ok. Left tx I don’t know what to do please help.
I’m 64 been on medicare and medicade sense 2006 and the insurance I have didn’t pay for my visits to my family doctor and I owe 3000 in medical bills
Thanks for your help!? Wow!
That’s our state officials for ya………not care!
I am not sure what you are looking for here. I cannot enroll you in insurance through comments – it requires a lot of personal information, so you’ll have to call in and speak to someone over the phone to enroll.
There are 2 household members, my son gets Medicaid and I’m on disability and have Medicare but can not afford the medications and dental.
I have Medicaid and Anthem thru that but I want to change it to another Insurance Co. Can I ?
Go to healthsherpa.com or call us at (872) 228-2549 to get this done.
How do I apply for hip Plus
Hip Plus is Indiana’s Medicaid. You can contact their state office to apply or to go healthsherpa.com
I do odd jobs like house cleaning ect just enough to pay my rent.
Me and two children
I have a problem with the household number
The household size is your tax household. You can call us at (872) 228-2549 if you have questions.
I went on here an sign myself up for blu shelid blu cross by accident I don’t want to keep this insurance please remove this insurance on me I can’t afford to pay for my meds I get them free threw supier medacaid please get it off please I have not taken any meds for months I am deathly sick and I need my meds please this is now a emergency please
Call us at (872) 228-2549
There is 2 people in my household my daughter has Medicaid.
Looking for dental coverage
Call us at (872) 228-2549 to enroll in dental.
I’m looking for health insurance and dental insurance.I can’t afford to go to doctors or pay for my meds.I suffer with toothache ,mental issues and high blood pressure.
I would call the market place amd have them help you out cause I have Humana and don’t have to pay anything for dr. Visit and my med I get through Humans Pharmacy.if you owe anything they let you know. You also get vision and dental and don’t have to pay for either.
I’m in desperate need of dental insurance
Delta dental is a good and affordable.
I am in desperate need of dental care. How quickly could I get on this plan and how fast does it go into effect? I am already on Medicaid and qualify by the income standards.
Call us to get dental insurance – (872) 228-2549
DHS tell me because I receive SSI I don’t qualify for edicaid but I qaulify for Medicare a&b but I have to wait till January 23 to apply I’m disabled and can’t wait that long for health care I take prescription medication on a daíly basis
You can give us a call at (872) 228-2549 to discuss your options.
Have SSI income, not covered by Medicaid, nor Medicare, need a coverage that covers prescriptions, Dental, like Medicare Part D.
You can call us at (872) 228-2549 to get help enrolling in health insurance.
I need to get dentures but I am trying to get implants and can’t afford them I have Medicare through the state if you can help me with dental that would be great. I can’t even get care Credit and I am low income right now I am having trouble with housing don’t have a stable place at this time. Please let me know if you cab help me
You can call us at (872) 228-2549 to get help enrolling in health insurance. We can’t help with housing, we specialize in health insurance.
I’m a single mother worked since I was 16. For some reason I always fall just a little above the income bracket line definitely don’t make that type of money for the cost of dental work I’m desperate need of that getting bad as years go. Where’s the program for the ones who pay taxes and work but need that little push to help us out. Frustrating that the state never helped with my children’s child support that I struggled to provide all their needs alone. Now that I’m older in age can’t even qualify for assistance when I’m in need. Yet worked so hard pay my tax share for others and ones who aren’t even from here so they receive all the help with everything especially medical needs . The cost for dental is no joke way expensive some of us working citizens
You can call us at (872) 228-2549 to get help enrolling in health insurance or dental.
We miss the income guidlines by like 200. A year🤦♀️ my husband needs insurance special dental can you help?
Call us at (872) 228-2549 and we can enroll you in dental over the phone