Welcome to the Agent and Broker Video Learning Center.
In this video, the term "Marketplace" refers to Federally-facilitated Marketplaces, or
FFMs, including FFMs where states perform plan management functions, and to State-based
Marketplaces on the Federal Platform, or SBM-FPs.
This video will provide a walkthrough of the functionality to report a loss of health insurance
coverage.
Consumers who lost qualifying health coverage
in the past 60 days or who expect to lose coverage in the next 60 days qualify for a
Special Enrollment Period, or SEP.
In addition, consumers who lost coverage more than 60 days ago, but since January 1, 2020,
and didn’t enroll sooner because they were impacted by the COVID-19 emergency, may still
qualify for a Special Enrollment Period.
Consumers should apply online through HealthCare.gov
to see if they qualify.
This scenario features Mark, who was employed by a construction company since 2019 and received
health coverage through this job.
However, due to the financial impacts
of the COVID-19 pandemic on his industry, Mark lost his job and his health coverage
in March 2020.
Based on this loss of coverage, he had 60 days before or after the date of coverage
loss to apply for and enroll in coverage through the Marketplace.
This is a type of Special Enrollment Period.
Shortly after Mark lost his job and employer coverage, Mark’s elderly mother was diagnosed
with COVID-19.
Mark’s mother quarantined in her house as she recovered from the virus.
Mark provided care for his mother throughout the time she was quarantined, which overlapped
with the end of his opportunity to enroll in individual health coverage through his
Special Enrollment Period.
Since Mark was caring for his mother, he missed his deadline to enroll in Marketplace coverage.
Now that he no longer needs to care for his
mother, he returns to his HealthCare.gov account to update and complete his Marketplace application.
Once in his HealthCare.gov account, Mark begins his Marketplace application and navigates
to the “Recent Coverage Changes” section.
Mark isn’t sure if he should select ‘yes’
or ‘no’ for this question, since he previously missed his Special Enrollment Period deadline
to enroll in coverage, so he selects the ”Learn more” link to get more information about
qualifying health coverage and reporting recent coverage changes.
From the help drawer, Mark learns he should select the name of each person on his application
who lost qualifying health coverage anytime since January 1, 2020, and couldn’t enroll
sooner because of the COVID-19 emergency.
Please note, qualifying health coverage includes
coverage offered through a job, individual coverage for a plan or policy bought by an
individual, COBRA, most Medicaid or CHIP, Medicare, or coverage through a family member’s
plan.
Visit the link in the description for more information on qualifying health coverage.
Consumers who qualified for a Special Enrollment
Period but missed the deadline to enroll due to the COVID-19 national emergency may be
eligible to enroll in coverage through another Special Enrollment Period.
The COVID-19 national emergency poses many different challenges that may prevent individuals
from enrolling in a qualified health plan (QHP) before the end of an enrollment period
for which they were eligible.
Mark also learns that anyone who has lost
coverage may be required to submit documents to confirm the loss of coverage and the date
the coverage was lost.
Mark lost qualifying health coverage in March 2020.
Based on the help drawer, he knows he should select ’yes’ on the application for a
recent loss of coverage.
He selects ‘yes’ which prompts the next
question about his last day of coverage.
Mark lost his coverage on March 31, 2020, so he inputs this date into the date of coverage
loss field.
Mark views the option to input the name of
his previous plan onto his Marketplace application, but he’s not required to.
Mark selects “Save & continue” to save this information in his application and then
proceeds through the rest of the application.
Because Mark lost qualifying coverage during
the COVID-19 national emergency and missed his original deadline to enroll because he
and his family were impacted by the COVID-19 pandemic, he will receive a Special Enrollment
Period that allows him to enroll in Marketplace coverage outside of Open Enrollment.
For more information on completing a Marketplace
application, or on missing an SEP enrollment deadline due to COVID-19, visit the links
in the video description.
This next scenario features Jane.
Jane was insured through COBRA continuation coverage by her former employer.
However, her former employer stopped contributing to the COBRA coverage on February 28, 2022
and Jane cannot afford to pay the full amount on her own.
Because of this, she may qualify for a special enrollment period (SEP) to enroll in a Marketplace
plan.
Jane will navigate to the “Recent Coverage Changes” section of her Marketplace application.
She isn’t sure if losing COBRA coverage is the same as losing qualifying health coverage,
so she will select the link for the help text, where she will find eligibility information
regarding the loss of COBRA coverage.
From the help drawer, Jane learns that she
should select ‘yes’ since her former employer stopped funding her COBRA coverage and she
now has to pay the full cost for her COBRA coverage.
Since Jane’s employer stopped contributing to the costs of her COBRA coverage, she will
select ‘yes’ to losing qualifying health coverage.
Next, Jane will provide the date in which she lost coverage.
The date of coverage loss is the last day that she had COBRA coverage that is paid for
with an employer contribution.
Since her employer stopped contributing on February 28, Jane will enter February 28,
2022.
Jane will view the option to input the name
of her previous plan onto her Marketplace application, but she’s not required to.
Jane selects “Save & continue” to save this information in her application and then
proceeds through the rest of the application.
Losing COBRA coverage qualifies Jane for a
Special Enrollment Period so she will be able to enroll in a Marketplace plan.
We hope this video has been helpful.
If you haven’t already, we encourage you to watch our other video for a full walkthrough
of the streamlined HealthCare.gov application where the applicant is seeking financial assistance,
linked to in the video description below.
If a consumer needs additional support regarding
eligibility for Special Enrollment Periods or missing Special Enrollment Period enrollment
deadlines, they should contact the Marketplace Call Center.