What is the 150 FPL SEP?

In 2022, the ACA Marketplace introduced a new Special Enrollment Period for people whose income falls below 150% of the Federal Poverty Line. Unlike most SEPs, there are no deadlines or limits on how often it can be used. Eligible individuals will be able to enroll in a free Silver plan with low deductibles. Below are some groups who can benefit from this change in Virginia (if their household income does not exceed 150% FPL).

Uninsured people who do not qualify for other affordable coverage

That means you cannot access this SEP if you have an affordable job-based insurance offer, or if you’re eligible for Medicaid.

Current Marketplace enrollees who want to change plans

Eligible current enrollees don’t have to wait to experience a Qualifying Life Event or for Open Enrollment to change plans on the Marketplace.

Lawfully residing immigrants who aren’t eligible for Medicaid

Immigrants who do not meet Medicaid’s strict eligibility requirements (including the five year waiting period) can access affordable, quality coverage using this SEP. 

What is a Special Enrollment Period?

Open Enrollment is the time during the year when anyone can apply or enroll in Marketplace coverage or select a new plan. Outside of Open Enrollment, you need to qualify for a Special Enrollment Period (SEP) to get new insurance or change your plan through the Marketplace. Most Marketplace SEPs last 60 days, but the 150 FPL SEP does not have a time limit.

What is the Federal Poverty Line?

Every year, the federal government sets income guidelines that are used to determine who is eligible for certain programs. This SEP applies to people under 150% FPL. In annual income, that’s $19,320 for a household of one and $39,320 for a household of four. You can find a chart with more information about the guidelines for coverage year 2022 here.

How can I apply?

You can apply for coverage on the Marketplace, by calling 1-800-318-2596 or visiting HealthCare.gov. If you applied in the past but are newly eligible because of this SEP, the Marketplace may attempt to reach you by phone or email. A navigator from Enroll Virginia can help you apply for coverage and select a plan. Click here to make an appointment for free, unbiased assistance.