Last month, the HealthCare.gov application was changed to add the Federal Emergency Management Agency (FEMA) special enrollment period (SEP) for people who live in an area affected by a natural disaster or other FEMA-declared emergency and lost qualifying coverage more than 60 days prior to their application for Marketplace coverage. Qualifying coverage includes, for example, job-based insurance and Medical Assistance coverage. Currently, all states are covered under the COVID-19 pandemic national emergency declaration, so the FEMA SEP applies to everyone at this time.
The FEMA SEP change to the HealthCare.gov application allows people who lost qualifying healthcare coverage at any time since January 1, 2020 to enroll in Marketplace coverage. Applicants using the FEMA SEP due to loss of qualifying coverage will need to provide proof of loss of coverage.
The FEMA SEP is broader than just the change to the HealthCare.gov application and provides the opportunity to enroll in Marketplace coverage if someone:
- Lives in an area during the period of a FEMA-declared disaster or emergency (currently, all states are covered under the COVID-19 pandemic national emergency declaration);
- Was eligible for another SEP since January 1, 2020; and
- Failed to use the SEP to enroll due to impacts from the FEMA-declared disaster (in this case, impacts from COVID-19).
This means that if someone was eligible for any special enrollment period in 2020 but did not enroll they may still qualify to sign up for coverage. If the applicant was eligible for a special enrollment period for some reason other than loss of coverage (for example, the birth of a child or a move) but did not enroll during their SEP due to the impact of COVID-19, they are eligible for the FEMA SEP but will need to contact the Marketplace call center for help.
The default effective date for the FEMA SEP is the first day of the month following enrollment and plan selection. Applicants can contact the Marketplace call center to request a coverage effective date retroactive as far back as the first day of the month following the month when the qualifying event occurred. For example, a person who lost her job and employer-based coverage in April but failed to enroll in Marketplace coverage during the normal 60 day SEP for loss of coverage could enroll now and ask for that coverage to be effective retroactive to May 1st.
People having trouble using this special enrollment period or with questions should call the Marketplace call center at 1-800-318-2596 or the Pennsylvania Health Access Network helpline at 1-877-570-3642. For a helpful chart of Marketplace special enrollment periods from Beyond the Basics, see here.