What is the 2022 Low Income Special Enrollment Period?

If your income does not exceed 150% of the federal poverty level you now qualify for an SEP.

Starting late March 2022, agents can enroll eligible clients through the new 150% Federal Poverty Level (FPL) SEP category. For Marketplace coverage, eligibility is based on the previous year’s FPL chart.

This new SEP was created to make it easier for low-income Americans to enroll in marketplace coverage throughout the year - not just during open enrollment or when they experience a qualifying life event.

Individuals in all FFM states along with State Exchanges of Colorado, Maine, Pennsylvania, New Jersey, California, and Rhode Island can apply for this SEP.

What are the Eligibility Criteria?

Eligible applicants can enroll in an ACA-compliant health plan through the marketplace year-round if:

An applicant’s household income does not exceed 150% of the federal poverty level (FPL)
If the applicant is eligible for a premium tax credit (subsidy).

This special enrollment period does not have limitations on how often it can be used, or the type of health plan that can be selected. But people with income up to 150% of the federal poverty level are strongly encouraged to select a Silver plan, which has built-in Cost-Sharing Reductions that make the coverage better than a Platinum plan.

Medicaid-eligible individuals or individuals in the Medicaid Gap are not eligible for this SEP.

For Applicants with Existing Coverage

An applicant with an eligible household income who is already enrolled in an exchange plan can use this SEP to pick a different plan, although deductible and out-of-pocket spending would reset to $0 for the year when the new plan starts.

However, the new rules do clarify that if a current applicant is adding a dependent to their plan:

• They can either add the dependent to the existing plan.
• Or switch to a Silver level plan and enroll the new dependent in that plan.

But the SEP cannot be used to switch the current enrollee to a non-Silver plan together with the new dependent.

Through this SEP, new clients who fit this eligibility can enroll in a Marketplace plan and existing clients could change their plan. If an existing client chooses to change their plan, their deductible and out of pocket max will reset.

Who is eligible for this SEP?

Clients are eligible for this SEP if they fit both of these criteria:

Have an estimated annual household income at or below 150% FPL
Are otherwise eligible for APTC*

*As a reminder: Consumers with income below 100% FPL but who do not qualify for Medicaid due to immigration status only may still be eligible for APTC if they meet all other Marketplace eligibility requirements. They would also qualify to use this SEP.

Who is not eligible for this SEP?

Clients must be eligible for APTC in order to use this SEP. That means they cannot be eligible for Medicaid or offered affordable employer-sponsored coverage. This also means clients who are in the Medicaid Gap (i.e. make less than 100% FPL in states that did not participate in Medicaid expansion) can’t use this SEP; nothing about this new SEP changes their eligibility for subsidies.

This SEP is live for the Federally-facilitated Marketplace and all plans on HealthSherpa. Implementation of this SEP varies for State-based Marketplaces.

What are the effective date rules?

This monthly SEP will follow accelerated effective date rules, which means you can enroll a client any day of the month and have their coverage start the first day of the next month. For example, if you enroll your client in a plan on 3/30/22, their coverage will begin on 4/1/22.

Articles in this section

Who is eligible for this SEP?

Who is not eligible for this SEP?

What are the effective date rules?

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