Healthcare.gov recently sent an email to registered brokers to let them know that “The American Rescue Plan (ARP) created more opportunities for lower-income consumers to access Marketplace health care coverage, including a new Special Enrollment Period for consumers with income less than or equal to 150 Percent of the Federal Poverty Level (FPL).” It’s a good reminder for agents who are looking for something to do now that the extended open enrollment period is over.

The Commonwealth Fund wrote about this low-income SEP back in September. Here are the highlights:

  • Through the end of 2023, people “with household income[s] below 150 percent of the federal poverty level (FPL) (i.e., up to $32,580 for a family of three)” can now “newly enroll in marketplace coverage or change plans once each month.” 
  • “Under the American Rescue Plan (ARP), these individuals currently qualify for a free or nearly free plan and generous cost-sharing protections.”

Unfortunately, as the article points out, “SEPs are underutilized.” Of the eight to 10 million Americans who become eligible for an SEP each year, “fewer than 15 percent of uninsured SEP-eligible people enroll in coverage.” That means there are a lot of prospects; this is a big opportunity.

It’s also worth noting that low-income seniors also have the option of signing up for coverage (or switching from one plan to another) on a quarterly basis. 

Medicare.gov points out on its website that people who qualify for both Medicare and Medicaid can “join, switch, or drop [their] Medicare Advantage Plan or Medicare prescription drug coverage” once during each of these periods:

  • January–March
  • April–June
  • July–September

Additionally, those who qualify for extra help paying for Medicare Part D can “join, switch, or drop Medicare drug coverage” once during each of those periods.

Finally, individuals enrolled in a State Pharmaceutical Assistance Program (SPAP) or those who lose SPAP eligibility can “join either a Medicare drug plan or a Medicare Advantage Plan with prescription drug coverage” once during the calendar year.

The moral of the story is that there are still plenty of people out there who need help and plenty of opportunities to help them—you don’t have to wait until the next AEP to do so.