The deadline for open enrollment through the Health Insurance Marketplace remains Monday, March 31 at 11:59 p.m. Eastern Standard Time. There is no extension of the March 31 deadline for open enrollment. However, depending on certain circumstances a consumer may be granted a special enrollment period or SEP. Special enrollment periods permit individuals to enroll in a qualified health plan outside of open enrollment.
The law and regulations provide for special enrollment periods (SEPs), which include, for example, life changes and errors in enrollment. Qualifying life events that create a special enrollment period include:
- getting married
- having, adopting, or placement of a child
- permanently moving to a new area that offers different health plan options
- losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
A special enrollment period also exists in the Federally-facilitated Marketplaces for consumers who are “in line” as of March 31 or experience errors in enrollment. Anticipated high consumer traffic may keep consumers from completing the enrollment process despite their best efforts to meet the deadline on HealthCare.gov or through the Marketplace call center. Those consumers who are “in line” by the March 31st deadline to complete enrollment should receive a special enrollment period to make sure they get covered. So, those who were in line or had technical problems with the website or call center can quickly come back and sign up as soon as possible. “In line” means that the consumer attempted to enroll and has started or completed an application but has been unable to complete the enrollment process due to circumstances beyond their control. It is important that consumers “make their best effort” to get enrolled promptly. The quickest ways to get enrolled right now are:
- go to healthcare.gov first and use the online application
- second best, call the Marketplace call center (800) 318-2596
- lastly, you can fill out a paper application and get it mailed in right away. To receive eligibility for an SEP, the paper application must be processed by April 7. This is not postmarked, this is processed by the London, Kentucky processing center.
An official SEP deadline has not been announced yet. Every effort will be made to get those “in line” enrolled as soon as possible. Not everyone will be granted an SEP. Special enrollment period determinations will be made based on circumstances beyond the consumers control and the consumer’s best efforts to get enrolled.
Enrollments made in the limited time after March 31 will have a May 1 coverage effective date provided that consumers who were “in line” pay their first month’s premium by the deadline set by their chosen insurance company. This is the coverage effective date that consumers would have had if they were able to complete enrollment by March 31 and is the normal effective date for enrollments between March 16 and April 15.
Consumers whose paper applications are processed by April 7 or whose applications were pending submission on review of supporting documentation on March 31 will be able to select a plan through April 30 to allow them time to receive an eligibility notice, and the coverage will also be effective May 1.
Consistent with previous CMS guidance, consumers who receive a special enrollment period for being “in line” by March 31 and select new coverage within the timeframes outlined in this guidance will be able to claim a hardship exemption from the shared responsibility payment (or “fine”) for the months prior to the effective date of their coverage, because they will be treated as if they had enrolled in coverage by March 31.
Need help? Learn how Oasis can help you navigate through the process of enrolling.