(1) SEPs
no longer utilized by the Federally-facilitated Marketplace and State-based
Marketplaces using the Federal Platform and Future CMS Actions, and (2)FAQs
on the Marketplace Residency Requirement and the Special Enrollment Period due
to a Permanent Move. The action we are taking today announces the elimination of several unnecessary
special enrollment periods, clarifies the definitions of other special enrollment
periods, and provides
stronger enforcement so that special enrollment periods serve
the purpose for which they are intended and do not provide unintended
loopholes.
1. Eliminating Unnecessary
Special Enrollment Periods: Last month, we announced that the Tax Season
special enrollment period will no longer be offered. Today we are announcing
the elimination of six other special enrollment periods that are no longer
needed. Just as the Marketplace evolves, so too does consumer behavior. The
rules we use to operate the Marketplace need to keep up with these changes. As
such, special enrollment periods are no longer available for:
- Consumers who enrolled with too much in advance
payments of the premium tax credit because of a redundant or duplicate
policy
- Consumers who were affected by an error in the
treatment of Social Security Income for tax dependents
- Lawfully present non-citizens that were affected by a
system error in determination of their advance payments of the premium
tax credit
- Lawfully present non-citizens with incomes below 100%
FPL who experienced certain processing delays
- Consumers who were eligible for or enrolled in COBRA
and not sufficiently informed about their coverage options
- Consumers who were previously enrolled in the
Pre-Existing Condition Health Insurance Program
We’ll continue to monitor how special
enrollment periods are used and may make changes in the future as Marketplace
systems and operations continue to improve.
2. Clarifying Eligibility: Our review of
current special enrollment periods also showed that some of the eligibility
guidelines need to be further clarified so consumers can understand the intent
and so they will not be abused. Today we are updating guidance to more clearly
define the special enrollment period that is available to consumers who
permanently moved, and as a result, gained access to new health plans.
Specifically, we clarify that this special enrollment period cannot be used for
a short-term or temporary move where the consumer doesn’t plan to stay in their
new location, including situations in which a consumer is admitted to a
hospital for treatment in a different area. This clarification is intended to
assist consumers, brokers, issuers and others in understanding who is eligible
for this special enrollment period.
If we identify other areas where the rules
for special enrollment periods are unclear, we will issue additional clarifying
guidance as needed.
3. Enforcing the Rules: Finally, we will
take steps to make sure that consumers understand and comply with the rules. We
will conduct an assessment of plan selections that are made through certain
special enrollment periods to evaluate whether consumers properly accessed
coverage. Our program integrity team will pull samples of consumer records
nationally and may request additional information from some consumers or take
other steps to validate that consumers properly qualified for these special
enrollment periods. The findings from the assessment will help us to inform
future policy and operational improvements to enhance program integrity.
Additional details will be provided in the coming weeks.
We will also emphasize more strongly to
applicants that the law requires that consumers provide accurate information to
the Marketplace, and they may be subject to penalties under federal law if they
intentionally provide false or untrue information.
CMS BLOG
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