New Special Enrollment Eligibility Program Offering $0 Premiums forLow-Income Floridians Earning Less Than 150% of the Federal Poverty Level
Tampa FL, March 23, 2022
Florida Covering Kids and Families Project Director Jodi Ray today shared the exciting news that The Centers for Medicare & Medicaid Services (CMS) has launched a new Special Enrollment Period specifically for Americans who earn less than 150% of the Federal Poverty Level (FPL):
CMS will offer a time-limited, monthly Special Enrollment Period (SEP) for APTC-eligible consumers with a projected household income at or below150% of the FPL. Ray stressed the importance of this dynamic new undertaking by the Federal Government, whereby those with incomes less than 150% of the federal poverty level — $19,320 for an individual and $39,750 for a family of four — can now select insurance plans with ZERO premiums, with a few having to pay a few dollars. “Many Floridians are facing tremendous stresses right now, particularly our lower income earners, dealing with rising food and fuel costs, paralyzing rents and other related hits to their household budgets, and the timing is perfect for this opportunity to help them gain or maintain health coverage for their families. Very soon, we are expecting the end of the federal Public Health Emergency, which will likely result in the transitioning of many Floridians from the Medicaid rolls, and this new SEP will help to cushion that blow for our neighbors most at-risk in communities throughout Florida.”
This SEP will be available to Florida consumers and in other states that operate under the Health Insurance Marketplace® and use HealthCare.gov. Consumers are urged to contact Covering Florida Navigators, available at no charge, to assist them in using the SEP Screener tool at HealthCare.gov/screener for help determining if they are eligible for the 150% SEP.
The regular Special Enrollment Period also remains available through October 31, 2022, for individuals and families who qualify due to life change circumstances, including moving to a new county, losing insurance through a job change, having or adopting a child, marriage, divorce, and other personal circumstances. Covering Florida Navigators can also help consumers determine eligibility at no cost. The tenth Open Enrollment Period begins on November 1, 2022, likely running into January 2023. The OE10 period allows all consumers to shop, choose and/or renew their policies for coverage in 2023.
Florida Covering Kids & Families at the University of South Florida partners with organizations collectively referred to as the “COVERING FLORIDA” consortium, to provide Navigator services across the state of Florida. Covering Florida Navigators provide free of charge outreach and enrollment services to any Floridian looking to enroll for health care coverage in the Federal Health Insurance Marketplace. We assist consumers with telephone, in-person, and virtual online enrollment service and provide public education and outreach activities at locations throughout the state. Our Navigators are trained and able to help consumers as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. Covering Florida Navigator services are free to consumers in all 67 counties, with confidential one-on-one, unbiased customer service.
A Question & Answer sheet regarding the new SEP program details is included with this release.
Florida Covering Kids and Families and its partners have been providing free Navigator services throughout the state of Florida since the first Open Enrollment period in 2013. The following ten partners comprise the 2021-2022 Covering Florida statewide consortium and are collectively known as “Covering Florida“:
• Big Bend Area Health Education Centers (AHEC) – Serving Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Liberty, Leon, Madison, Taylor, Wakulla, and Washington counties
• Epilepsy Florida (South Florida Navigation) – Serving Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach, and St. Lucie counties.
• Family Healthcare Foundation – Serving Hillsborough, Pinellas, Pasco, and Polk counties
• Health Planning Council of Northeast Florida– Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties.
• Health Planning Council of Southwest Florida– Serving Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Highlands, Lee, Manatee and Sarasota counties.
• 90 Works– Serving Escambia, Santa Rosa, Okaloosa, and Walton counties.
• Primary Care Access Network (PCAN, Covering Central Florida)– Serving Lake, Orange, Osceola, and Seminole counties.
• Suwannee River Area Health Education Centers (AHEC) – Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Levy, Marion, Putnam, Sumter, Suwannee, and Union counties.
• United Way of Brevard – Serving Brevard County.
• University of South Florida Navigators– Providing Toll-Free and Virtual Services in ALL FL COUNTIES
The number of Floridians enrolled in the Marketplace each year has consistently exceeded expectations over the past couple of years. Florida year after year leads all Marketplace states in the United States in enrollments. Consumers who are unable to secure insurance through employment or other programs owe it to themselves and their families to #GetCovered and insure themselves against potentially lifechanging health related emergencies and developments. Contact Covering Florida at 877-813-9115 or www.CoveringFlorida.org
Florida Media Contact: Jody Young cell: 561-704-3912 email: CoveringFLA@gmail.com
The project described was supported by Funding Opportunity Number NAVCA210430-01-00 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the
responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
Questions and Answers
Q: When can consumers access this 150% SEP?
A: From March 18, 2022, through December 31, 2022, APTC-eligible consumers with expected household incomes at or below 150% of the FPL can get the 150% SEP by submitting a new application or updating an existing one themselves online at HealthCare.gov, the Marketplace Call Center or with free assistance from a Covering Florida Navigator. November 30, 2022 is the last day to confirm having an expected household income at or below 150% FPL and select a plan for plan year 2022 coverage that starts December 1, 2022.
Q: How long can consumers select a plan?
A: Unlike most other life event based SEPs, the 150% SEP doesn’t have a deadline. In other words, consumers qualify as long as they’re APTC-eligible and have an expected household income that does not exceed 150% FPL. However, consumers must select a plan before the end of the calendar month they submit or update their application for their coverage to start on the first of the next month. For example, no matter if a consumer submits a new or updated application on April 1 or April 16, they’ll have until April 30th to choose a plan for coverage that starts May 1st.
Q: How can consumers get this new 150% SEP?
A: In Marketplaces like Florida that use HealthCare.gov, APTC-eligible consumers with a household income at or below 150% FPL can submit a new application or update an existing application online themselves or with the help of an EDE partner, a DE partner that supports SEPs, or the Marketplace Call Center. Covering Florida Navigators are available to assist for no fees. The application automatically determines consumers’ eligibility for the 150% SEP. Throughout plan year 2022, consumers eligible for this SEP are also generally eligible for free or low-cost plans with very low deductibles and out-of-pocket costs.
Q: Will consumers have to go through the SEP pre-enrollment verification process or submit additional documents to qualify for the 150% SEP?
A: No. Consumers who qualify for the 150% SEP don’t need to submit documentation to confirm their SEP eligibility. CMS notes that consumers with open or new data matching issues (DMI) are still required to submit documentation to the Marketplace to keep their financial help. Finally, as eligibility for the 150% SEP requires that consumers be APTC-eligible with a projected household income at or below 150% of the FPL, CMS notes that is it important that consumers return to their application as soon as possible to report any changes in their household or income as it may impact their 150% SEP eligibility.
Q: Can a consumer change plans more than once under the 150% SEP?
A: Yes, once per month, as long as the consumer maintains APTC-eligibility and a projected household income at or below 150% FPL. While consumers may change plans monthly during this opportunity, they (and their household), may be subject to certain plan category limitations. Also, CMS notes that it may cost consumers more to change plans more than once during the current 2022 plan year because their annual deductible amounts, cost-sharing, or other out-of-pocket expenses may reset.
Q8: What will issuers and direct enrollment partners need to do to appropriately process the consumers through this new 150% SEP?
A: Issuers should be prepared to support the processing of enrollment transactions, known as “834” transactions, for this SEP. These enrollment transactions contain the SEP reason code of “FC.” Direct enrollment partners (both EDE and DE Classic Partners) may also have additional preparation activities in place related to consumer screener questions and consumer plan display pages.