During the Lockdown and Pandemic 12 states across America, who have state-based health exchanges like Covered California, are allowing a Pandemic Special Enrollment (P-SEP) for people to enroll into health insurance even if they do not have another Qualifying life event.  Many people are concerned with having enough health coverage if they or their family gets sick during the pandemic. In most states people will have to wait until November to apply for health insurance during the Open Enrollment Period (OEP). This happens every year starting in November. But 12 state who have their own Health Insurance exchanges like Covered California in California or Connect for Health Colorado in Colorado have made a special, one-time only opportunity, or Special Enrollment Period, for their residents to enroll into a state health insurance program. This PSEP is specifically if somebody is wanting to enroll because they are concerned about not having enough coverage during the pandemic. Today we are going to talk about what are these new SEP’s, who can apply and when will the special enrollment periods end. Please don’t forget to like and subscribe.

What is Health Exchange and what are Special Enrollment Periods (SEP)

• Health exchanges were established by the Affordable Care act
• Allows individuals to buy private health insurance plans like:

• • Anthem, Blue Shield, Kaiser, Humana, Healthnet, Molina
  • Similar to insurance plans you can get directly with a carrier or through your work
  • These plans can be purchased through a health exchange
• These exchanges provide financial help for people to buy health insurance
• Based on
  • Households
  • Income
  • Age
  • And location
• These exchange plans are not Medicaid or Medi-Cal
• If you apply for Medicaid through the exchange, the exchange will send your information as a referral to your local Medicaid agency
• Health exchanges only deal with private insurances

Healthcare.gov vs State based

• Two types of health exchanges Federal Exchange vs State Based exchanges
• States were allowed to establish their own health exchange in the beginning if they chose to.

By establishing own exchanges states could:

• Provide more financial support
• Change benefit structure of health plans
• Change when people within that state could apply

OEP vs SEP

• Another important key to this is
• Open Enrollment Period vs Special Enrollment Periods

• This is important because normally people can only apply during open enrollment period, or if they have a life change
• Like: lost work insurance, got divorced, moved and a few other
• But “need” like I got sick or hurt is not a special enrollment reason
• Both Federal exchange and State Exchanges follow these rules
• Now these 12 states that have their own exchanges are allowing people to enroll if they are concerned about not having enough health coverage during the Lockdown and the Pandemic
• These states are: California, Colorado, Connecticut, Washington DC, Massachusetts , Maryland, Minnesota, New York , Rhode Island, Washington and Virginia

What is the SEP for Covered California and other State Based Exchanges and when will it end?

• The SEP is available until June 30th
• The SEP allows people who lost their work insurance
• Or who do not have any health insurance coverage at all to apply
• Solely based on their concern around the pandemic
• This SEP is a onetime only opportunity to enroll and if somebody is eligible for the coverage it would allow them to choose a private health insurance plan and still get subsidy if they fall within the income limits.
• Income limits here in California for household of 4 are up to  $157,000

If dont enroll in time to qualify for the Pandemic SEP 

If you are note enrolled by end of June 30th you may still be eligible for other types SEP’s

• This also applies if you live in a state that doesn’t have the Pandemic-SEP
• Normal SEP triggers:

• Life changes

• • Had a baby (but not getting pregnant)
  • Moved into the state
  • Lost insurance from anywhere else

• • • Work insurance
    • Parents / Spouses insurance
    • Lost Medi-caid or Medi-Cal
    • Got divorced
    • A few more
• With these qualifying events you can still apply in any state within 60 days.

Thank you so much for watching, if you have questions about your Medicare or Medicare health plan options please feel free to contact us and we can make a new post or video to cover your questions. We here at California know health insurance weather it is private health insurance, Medicare, Medicaid / Medi-Cal, MediGap or health insurance for your small business. It can be very confusing coming from your work insurance and trying to look at options on the private market or turning 65 and trying to figure out which Medicare option is best for you. That is exactly what we can do, we can walk you through your options and help you find the plans that fits your needs and your budget.