Expanded Access to Subsidized Marketplace Insurance Plans

Content From: TargetHIVPublished: March 02, 20223 min read


Affordable Care Enrollment TA Center

Cross-posted from: TargetHIVExit Disclaimer

Did you know? Most people with very low incomes can now enroll in subsidized Marketplace coverage.

A new SEP is available for individuals eligible for Advance Premium Tax Credits (APTCs) and with income below 150% FPL starting January 2022.

The SEP is available monthly, meaning that qualifying low-income individuals without insurance will be able to enroll in subsidized Marketplace coverage throughout 2022.

Individuals can qualify for this new SEP if they meet all of the following income and APTC eligibility criteria:

  • Their annual household income is at or below 150% FPL in their state. (View the 2021 FPL guidelines here. There is no pre-enrollment income verification requirement, which means that individuals can self-attest their estimated household income for 2022.)
  • They do not file a Married Filing Separately tax return.
  • They cannot be claimed as a tax dependent by another person.
  • They, or a family member, are not eligible for “minimum essential coverage” outside of the Marketplace, including certain offers of employer-sponsored coverage.
  • They, or a family member, are not eligible for coverage through Medicaid, Medicare, CHIP, or TRICARE.

This SEP will become available on the HealthCare.gov application in late March 2022, but assisters and navigator staff can help their clients enroll now by contacting the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).

Qualifying individuals already enrolled in Marketplace coverage will have the opportunity to switch plans monthly, but will be limited to switching to a silver plan. Switching to a new plan mid-year will reset the deductible and out-of-pocket maximum. Individuals who are enrolling in new coverage through the low-income SEP can pick any metal level plan.

Please note that this new SEP will be available in states using HealthCare.gov. States using state-based exchanges have the option to adopt this SEP. Of the state-based exchanges, only Maine has implemented the new low-income SEP, but other states have indicated they may implement it in the future. It is important to continue to check with your state exchange for any updates to SEPs.

This SEP will only be available for the years in which individuals are eligible for the enhanced subsidies enacted through the American Rescue Plan, which as of now means it will be available only for the 2022 plan year. Learn more about this new SEP.

Qualifying Events that Create Other Special Enrollment Periods

There are many qualifying events that create Special Enrollment Periods, including common life events and special circumstances.

For example, people who lose employer-based health coverage because of losing or quitting their job are eligible for the “loss of coverage” SEP. This SEP also applies for people who lose their employer coverage because their work hours have been reduced, or because their employer is now contributing less (or nothing at all) to the premium amount. This SEP also applies when a spouse has lost employer-based health coverage.

Check out the ACE TA Center’s Special Enrollment Periods Consumer Fact SheetExit Disclaimer for details.

Reminder: Enhanced Premium Tax Credits Are Available in 2022

Because of the enhanced premium tax credits made available through the American Rescue Plan Act, individuals with income below 150% FPL are currently eligible for $0 premium plans for the 2022 plan year. Individuals with household income above 400% FPL are also eligible for premium tax credits that cap the amount they will pay in premiums to 8.5% of their income. Beyond the enhanced premium available in 2022, many individuals are eligible for premium tax credits and cost-sharing reductions to make their plans more affordable.

Check out the ACE TA Center’s FAQ: Premium Tax Credits (PTCs) and Cost-Sharing Reductions (CSRs)Exit Disclaimer and Exit DisclaimerPTC/CSR eLearning ModuleExit Disclaimer to learn more about who is eligible and how to apply.