UPDATED: JULY 05, 2023 | 3 MIN READ
You may be eligible for a new 16-month Special Enrollment Period if you recently lost Medicaid coverage. You can sign up for health insurance through the Marketplace outside the usual Open Enrollment Period. Please keep reading to learn more about this Special Enrollment Period and how to use it.
Unwinding SEP for individuals losing Medicaid coverage
The 16-Month Special Enrollment Period is an important opportunity for those who recently lost Medicaid coverage. This SEP will allow consumers to enroll in a better health plan that fits their needs.
During this Unwinding SEP, individuals will have the chance to review options and compare plans to identify one that can provide quality care at an affordable cost.
Consumers should be aware of this special 16-month enrollment period; it is a great way to understand the various options available and find coverage that best fits their needs.
How long is the Unwinding SEP?
The 16-Month Special Enrollment Period begins on March 31, 2023, and will run through July 31, 2024. The SEP allows newly qualified individuals to enroll in healthcare coverage regardless of the open enrollment timeline.
This 16-month period applies explicitly to those who have lost Medicaid during this time frame – and serves as an important measure in providing quality healthcare coverage during a crisis.
What does the Unwinding SEP allow?
The 16-Month Special Enrollment Period allows those who’ve lost their Medicaid coverage to enroll in a health insurance plan through the Marketplace.
Starting March 31, 2023, and running until July 31, 2024, individuals that missed the Initial Enrollment Period can use this SEP to find coverage options on healtghcare.gov that meet their needs.
Especially for those people without access to employer-sponsored health insurance, this SEP can provide critical access to adequate and affordable care.
In response to the unprecedented challenges posed by the high number of redeterminations, the Center for Medicare and Medicaid Services has created the temporary Unwinding Special Enrollment Period to facilitate the transition to other coverage for consumers.
The Centers for Medicare & Medicaid Services states that Medicaid or CHIP beneficiaries might be perplexed as to why their coverage is coming to a close after a few years.
Especially since they may not have received any communication from their state agencies since the Maintenance of Effort (MOE) was implemented in 2020.
As this could lead to many people losing their benefits, state agencies may lack the resources to provide everyone with the information needed to switch to a Marketplace plan within the allotted 60-day Special Enrollment Period.
Who’s eligible for the 16-month Special Enrollment Period
If you’ve had Medicaid coverage at some point in the last 12 months and don’t have an active enrollment in any other type of plan, then you may be eligible for 16 months of special enrollment.
Individuals who meet these requirements during this allotted time can take advantage of the unique healthcare opportunities provided by this 16-Month SEP. Don’t miss out on medical assistance you could require over the coming 16 months – investigate your eligibility today.
Eligible individuals are given a 16-month time frame to submit either a new or updated application for the SEP. The application must demonstrate a loss of Medicaid or CHIP coverage; no documentation is needed.
Once the applicant applies on healthcare.gov, consumers will have 60 days to select a plan, and the coverage can commence on the first day of the following month.
16-month Special Enrollment Period coverage options
The 16-Month Special Enrollment Period is an excellent opportunity for individuals who have lost their Medicaid coverage. It allows them to gain access to affordable healthcare options.
This SEP is available in all states participating in the Federally-facilitated Marketplace or having a Partnership Marketplace. They also can use the Healthcare.gov platform for its individual marketplaces.
The Centers for Medicare and Medicaid Services advises consumers whose Medicaid or CHIP eligibility has been terminated to apply for Marketplace coverage immediately.
Furthermore, those whose Medicaid or CHIP coverage has been terminated for administrative reasons should also apply. This allows the Marketplace can evaluate their eligibility for Medicaid or CHIP coverage or subsidies for Marketplace coverage.
Individuals don’t need to wait until their coverage terminates to apply. Current rules allow them to report a loss of coverage up to 60 days before their Medicaid or CHIP termination. If an individual is eligible for multiple Special Enrollment Periods, they can select the earliest effective date.
FAQs
Who is eligible for the 16-month Special Enrollment Period?
Individuals and their families who lose Medicaid aren’t eligible for employer healthcare or Medicare.
Why are the Centers for Medicare and Medicaid Services offering this Unwinding SEP?
State governments and other stakeholders have expressed significant worries that Medicaid and CHIP beneficiaries could face extraordinary obstacles when switching to other forms of coverage, such as Marketplace coverage.
Medicaid and CHIP beneficiaries may not understand why their Medicaid or CHIP coverage is terminating after several years without contact or consistent communication from their state Medicaid agencies.
When can people access this Unwinding SEP?
From March 31, 2023, to July 31, 2024, consumers losing Medicaid, CHIP, or BHP coverage can choose a new plan. They can do this by accessing the Unwinding SEP by submitting or updating an application through HealthCare.gov.
They can also use a certified partner that supports SEPs, or the Marketplace Call Center. If eligible for this Unwinding SEP, they have sixty days from submitting a new or updating an existing HealthCare.gov application to select a plan.
When will coverage start for consumers eligible for the Unwinding SEP?
Once an individual selects a new plan, Marketplace coverage will become effective the first day of the month following selection. For example, if a plan is chosen on August 20, 2023, Marketplace coverage will commence on September 1, 2023.
Get help finding healthcare options after losing Medicaid
The new SEP is an excellent opportunity for those who have lost their Medicaid coverage. These individuals can enroll in a health insurance plan through the Marketplace. This SEP is available to all states that use the healthcare Marketplace. It’s also available in any state with a Partnership Marketplace or uses the Healthcare.gov platform for its individual marketplaces.
Look no further if you need help finding healthcare options after losing Medicaid. Get assistance by calling us at the number above or reviewing options online by filling out our online rate form.
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