Note: This message is intended for Georgia and Florida assisters only
The Centers for Medicare & Medicaid Services (CMS) is providing additional opportunities to enroll in Federally-facilitated Exchange (FFE) coverage for certain individuals affected by Hurricane Michael in Florida and Georgia.
In early October 2018, CMS issued press releases that announced the availability of a Special Enrollment Period (SEP) for certain individuals who were seeking coverage in Qualified Health Plans (QHPs) through the FFE and who were impacted by Hurricane Michael. The press releases referenced the August 2018 CMS Guidance on Special Enrollment Periods (SEPs) related to Emergency and Major Disaster Declarations by the Federal Emergency Management Agency (FEMA).
Individuals eligible for a SEP related to this guidance have up to 60 days from the end of the FEMA-designated incident period to select a new QHP through the FFE or to make changes to their existing QHP enrollment. In Florida, the end of the SEP was December 18, 2018, and in Georgia, it was December 22, 2018.
On December 21st, we further announced that individuals in the Florida and Georgia counties that FEMA designated as eligible to apply for “individual assistance” or “public assistance” under a major disaster declaration due to Hurricane Michael who were unable to enroll during an enrollment period for which they were eligible will have an additional 60 days after the end of the first Hurricane Michael SEP to enroll in coverage. In Florida, eligible consumers will have until February 16, 2019 to enroll in Exchange coverage. In Georgia, qualifying consumers will have until February 20, 2019 to enroll.
Who is Eligible?
To enroll in coverage under this SEP, individuals must contact the Marketplace Call Center at 1-800-318-2596 or TTY at 1-855-889-4325, and attest that they meet the following eligibility requirements:
- They resided in any of the counties that are eligible to apply for “individual assistance” or “public assistance” by FEMA either during the FEMA-designated incident period for the major disaster for Hurricane Michael, or at the time of application for enrollment; and
- They were affected by the disaster, and that it prevented them from completing enrollment.
For a list of Florida counties that FEMA designated as eligible to apply for “individual assistance” or “public assistance” under a major disaster declaration due to Hurricane Michael, see: https://www.fema.gov/disaster/4399.
For a list of Georgia counties that FEMA designated as eligible to apply for “individual assistance” or “public assistance” under a major disaster declaration due to Hurricane Michael, see: https://www.fema.gov/disaster/4400.
What documentation is needed?
Marketplace SEP pre-enrollment verification requirements may be waived for consumers who are eligible for this SEP. Consumers must attest that they live or did live in the impacted area during the FEMA major disaster declaration for Hurricane Michael and were unable to complete enrollment within 60 days from the end of the first SEP offered related to the Hurricane. No further documentation is needed.
Steps to helping a consumer access this SEP:
- Help the consumer complete a 2018 and/or 2019 Marketplace application online, depending on their needs, at HealthCare.gov. After completing the online application, the consumer may receive an Eligibility Determination Notice stating that he or she is not eligible to enroll in 2019 coverage because the Open Enrollment period for 2019 has ended.
- Next, help the consumer call the Marketplace Call Center (no later than February 16, 2019, if you are in Florida, or February 20, 2019, if you are in Georgia). Inform the consumer to let the Call Center representative know that he/she was impacted by Hurricane Michael and was unable to apply for 2018 coverage using a SEP for which he/she was eligible, or 2019 coverage during Open Enrollment or using a SEP for which he/she was eligible.
- Each SEP request will be evaluated by a Marketplace Caseworker, which may take several days. Caseworkers will review an individual’s eligibility for the SEP using available information from Marketplace consumer records and public information on FEMA declarations.
Once the Marketplace determines his/her SEP eligibility, the consumer will receive a notice by mail with his/her result. If he/she was determined SEP eligible, you can then help the consumer go back to HealthCare.gov and select a plan.