Special Enrollment Periods Available for Michigan Residents Affected by COVID-19

Due to the 2019 Novel Coronavirus (“COVID-19”) pandemic, many Michigan residents have found themselves without any health insurance coverage. On September 15, 2020, the Michigan Department of Insurance and Financial Services (“DIFS”) released a press statement informing Michigan residents that extended health insurance enrollment periods are available for qualified residents through the Health Insurance Marketplace.

Special Enrollment Periods (“SEPs”) allow individuals who missed the yearly open enrollment period but have experienced a specific life event to sign up for health insurance. Generally, individuals have 60 days before and 60 days after a qualifying life event to enroll in an insurance plan through the Health Insurance Marketplace. Life events that qualify individuals to enroll in an SEP include: household changes, such as marriage, divorce, or the birth of a child; changes in residence; and a loss of health insurance. Typically, if an individual misses an SEP enrollment window, he or she must wait until the next open enrollment period to apply.

Individuals who have lost healthcare coverage due to job loss during the COVID-19 pandemic may still be eligible for coverage through various healthcare outlets. Those who have lost health insurance as a result of job loss may become eligible for Medicaid if they live in a state with expanded Medicaid under the Affordable Care Act (“ACA”) and meet certain income limits. Michigan is one such state that has expanded Medicaid coverage under the ACA. Additionally, ACA Marketplace coverage is available to those who do not have employer sponsored health insurance and do not qualify for Medicaid. Furthermore, subsidies may be available to individuals with a family income between 100% and 400% of the poverty line. COBRA is another option for those who lost job-based health insurance. COBRA will allow employer-based coverage to continue after employment ends, however, this is often a costly option because the individual must pay the entire premium as well as an additional 2%.

Michigan residents who lost health insurance during the COVID-19 crisis after the original SEP enrollment window closed or were uninsured while working will not be eligible for an extended SEP based on coverage loss. In addition, the federal government has decided against opening an SEP for these individuals to obtain coverage. However, because all 50 states have been declared a Federal Emergency Management Agency (“FEMA”) natural disaster area, FEMA has declared that any individual in the country who lost health insurance after January 1, 2020 and did not enroll in a plan because of COVID-19 may now enroll under the new FEMA SEP. It has not yet been specified how much additional time individuals have to enroll, so eligible individuals should enroll as soon as possible.

These new SEPs are not just available to individuals insured through the Marketplace. Because COVID-19 impacted nearly every American, even individuals with off-Marketplace insurance or individuals who had their income reduced can apply for additional SEPs. Michigan residents can utilize these SEPs to enroll in a plan through the Health Insurance Marketplace and may now apply for premium tax credits. Michigan residents are encouraged to determine their SEP eligibility by visiting the Marketplace Screener website.

For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in Special Enrollment Periods and other rules and regulations that may have an impact on health insurance coverage. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.