Employee Benefits Compliance, Exchanges, Exchanges / Marketplaces / Subsidies, Marketplaces

Special Enrollment Period for Federal Exchanges: March 15 – April 30

health care coverage

On February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a special enrollment period (SEP) for March 15th  – April 30th in the Federally-facilitated Marketplace (FFM), for  individuals and families who did not have health coverage in 2014 and were subject to the tax penalty or “shared responsibility payment” when they filed their 2014 taxes.  The purpose of this special enrollment period is to allow people who were unaware or didn’t understand the implications of this new requirement (until the filed their 2014 tax returns) to enroll in 2015 health insurance coverage through the FFM and avoid future penalties.

This CMS special enrollment period applies only in states that use the Federally-facilitated Marketplaces (FFM), although it is possible that states with state marketplaces could also allow a special enrollment period for similarly situated individuals.

Requirements to Qualify for the Special Enrollment Period

To qualify for the Special Enrollment Period, an individual must:

  • Live in a state with a Federally-facilitated Marketplace, and
  • Not currently be enrolled in coverage through the FFM for 2015, and
  • Attest that they when they filed their 2014 tax return they paid the penalty/tax for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the “shared responsibility payment” after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

Fees for Taxpayers Who do Not have Health Coverage or an Exemption

The annual fee (or “penalty” or “tax”) for taxpayers who did not have health coverage for all of 2014 and who did not qualify for an exemption is the greater of $95 (per adult) or 1 percent of income.   In 2015 the annual fee increases to the greater of $325 per adult or 2 percent of income.  Individuals who enroll during this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015, but they can get coverage for the rest of 2015 and avoid additional fees for 2015.  For individuals who enroll in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Additional Information

Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by Clicking Here. Consumers can find local help or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.  More information about Health Insurance Marketplaces