CHA News Article

CMS Modifies Special Enrollment Period Rules for Federally Facilitated and State-Based Marketplaces

The Centers for Medicaid & Medicare Services (CMS) announced this week that six special enrollment periods will no longer be utilized by the federally facilitated marketplaces and state-based marketplaces using the federal platform. CMS also clarified eligibility and announced steps it will take to ensure consumers understand and comply with the rules around special enrollment periods. 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 who 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 percent of the federal poverty level who experienced certain processing delays;
  • Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options; and
  • Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program.

CMS will continue to monitor how special enrollment periods are used and may make future changes as marketplace systems and operations continue to improve. More information is available in the attached fact sheet and on the CMS website