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Health Benefits

Qualified Health Plans on the NYS of Health Marketplace: Changes under COVID-19

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Summary

The NY State of Health has opened a special enrollment period allowing individual who are uninsured to enroll in a Qualified Health Plan, as well as allowing a grace period to pay for a health plan’s monthly premium. The period has been extended through September 15, 2020.

If you are a Benefits Plus subscriber, for additional information on Qualified Health Plans, refer to Benefits Plus, Health Programs, Affordable Care Act, Plans on the Marketplace & Who Qualifies, Qualified Health Plans. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

Special Enrollment Period

NYS: EXCEPTIONAL CIRCUMSTANCES

New York State has created an “exceptional circumstances” special enrollment period for anyone who is uninsured during the COVID pandemic. These individuals can enroll in a Qualified Health Plan on the NY State of Health Marketplace or directly with a health insurer from March 16th through September 15th.

Individuals apply for coverage through NY State of Health on-line at https://nystateofhealth.ny.gov, by phone at 855-355-5777, or by working with Navigators: https://info.nystateofhealth.ny.gov/IPA.

For additional information on special enrollment periods visit.

FEDERAL SPECIAL ENROLLMENT PERIOD

Individuals qualified to enroll in Marketplace coverage during the Open Enrollment or a Special Enrollment Period (SEP) but were unable to enroll due to a hurricane or other natural disaster, may be eligible for another Special Enrollment Period.

The FEMA SEP gives people extra time to enroll if they reside in an area during the incident period of a FEMA-declared disaster or emergency (currently, all states are covered under the COVID-19 pandemic national emergency declaration), and they were eligible for another SEP, but they failed to enroll during the SEP for which they were eligible due to impact of the FEMA-declared disaster, that is, from COVID-19. This means that if someone was eligible for a SEP at some point this year but did not enroll, they may still qualify for coverage. Note that people who haven’t had any SEP-qualifying events since January 1st are not eligible for this FEMA SEP.

The applicant will need to prove that they lost coverage. If the applicant was eligible for an SEP other than for loss of coverage (for example, birth of a child or a change of permanent residence), but failed to enroll due to the impact of COVID-19, they are still eligible for the FEMA SEP but must contact the Marketplace call center for help.

The default coverage effective date for the FEMA SEP is the first day of the month following plan selection. However, a consumer can contact the Marketplace call center to request a retroactive effective date. The earliest effective date is the first day of the month following the qualifying event for the original SEP and the FEMA-designated incident start date.

If eligible, the individual has 60 days from the end of the FEMA-designated incident period to complete their enrollment in Marketplace coverage and request a retroactive start date based on when they would have picked a plan if not for the disaster. See the following link for FEMA designation information: https://www.fema.gov/disasters.

No Cost Sharing for COVID-19 Testing

There is no cost sharing for Covid-19 testing for individuals enrolled in qualified health plans.

When Household Circumstances Have Changed

Households should update their account within 60 days of the change on the NYS of Health Marketplace. Anyone who has experienced a change in income, employment or other major life event, may qualify for more financial help that could lower their health insurance costs.

Payment of Plan Premiums

Individuals enrolled in subsidized or unsubsidized coverage in NYS may have more time to pay their health insurance premiums during the COVID-19 emergency. For more information on this grace period visit the Department of Financial Services at https://www.dfs.ny.gov/press_releases/pr202003301 and the NYS of Health Marketplace.

For a fact sheet, click here.

NY State of Health Fact Sheets

How COVID-19 Cash Aid Impacts the Premium Tax Credit and Cost Sharing Reduction Subsidy

ECONOMIC IMPACT PAYMENTS

The CARES Act Economic Impact payments (EIP) (up to $1,200 per individual, $500 per qualifying child) will not count when determining eligibility for the premium tax credit or the cost sharing reduction benefit.

PANDEMIC UNEMPLOYMENT COMPENSATION

The $600 per week in Pandemic Unemployment Compensation will count when determining eligibility for the premium tax credit and the cost sharing reduction benefit. The base Unemployment Insurance benefit, including PUA, also counts as unearned income.