Frequently Asked Questions (FAQs) About Unwinding Medicaid Special Enrollment Period

The Centers for Medicare and Medicaid Services (CMS) has recently made a statement regarding the unwinding of Medicaid continuous enrollment and has also announced a special enrollment period for people who will lose their coverage due to this. As this is a new event and the enrollment process is also starting shortly, it could be confusing for many people, especially those who are losing their coverage.

If you are one of those people who will be affected by this new development, you might have countless questions running through your mind. In this article, we have tried to answer the frequently asked questions about the unwinding of Medicaid enrollment and the temporary special enrollment period.

Q1: What announcement did CMS make on January 27, 2023?

With the termination of continuous enrollment condition, which is being referred to as “unwinding SEP,” the CMS made an announcement on January 27, 2023, that there will be a Marketplace Special Enrollment Period (SEP) for people who will be losing their Medicaid or CHIP coverage. Unwinding SEP will be an opportunity for individuals and families to get healthcare coverage through HealthCare.gov outside the Open Enrollment Period (OEP).

Q2: Why is this unwinding SEP important for me?

When the continuous enrollment condition ends, consumers will need to shift to other coverage forms, such as Marketplace coverage, as their Medicaid and CHIP coverage will be terminated. This temporary unwinding SEP will provide an opportunity for individuals and families to have coverage without any gaps. It is an especially important period as millions of people are expected to lose coverage in the coming months. Due to the massive number of consumers being affected, the Medicaid and CHIP agencies might be able to guide you about your alternative coverage options within 60 days.

Q3. When can I apply for unwinding SEP?

If you are losing your Medicaid or CHIP coverage, you can access the unwinding SEP by calling us and allowing us to assist you in submitting a new application or updating a previous one on healthcare.gov between March 31, 2023, and July 31, 2024. Our services are free for you to use and we have access to all the carriers in your area. You will have a 60-day time window after submitting or updating your application to choose a new healthcare plan.

Keep in mind that you will not have to wait for your coverage to end before starting an application on Marketplace coverage. You can submit or update your application up to 60 days before the last day of your Medicaid or CHIP coverage ending date.

Q4: When will my new Marketplace coverage start?

If you are eligible for the unwinding SEP and have selected a new Marketplace plan, your new coverage will start on the first day of the following month. For instance, if you choose a plan on July 12, 2023, your new plan will begin covering you from august 1, 2023.

Q5: Who will I check my eligibility for unwinding SEP?

You will be eligible for the unwinding SEP if you have lost or about to lose your Medicaid or CHIP coverage. The CMS has updated the application process on HelathCare.gov. It will ask you if you have lost your Medicaid or CHIP coverage. Answering “yes” to this question is all you need to become eligible.

Q6: Will I need to provide additional documents to verify my eligibility for unwinding SEP?

No, you will not need to provide any additional documentation of qualifying events to become eligible for unwinding SEP, as losing Medicaid or CHIP coverage will automatically make you eligible.

Q7: When will my Marketplace coverage start if I have more than one qualifying event?

If you have faced another qualifying event other than losing your coverage, you will be eligible for more than one special enrollment period. In this case, you will get the earliest coverage on the date associated with the applicable SEP. For example, if you are eligible for an unwinding SEP and another SEP, your coverage will take effect on the date associated with the unwinding unless the other SEP is offering a retroactive coverage effective date. Furthermore, if the other SEP is offering retroactive coverage but you do not want your coverage to start on the date of your qualifying event, you can request the Medicaid agency to change your starting date by calling their Call Center.

Q8: What if I am unsure about my Medicaid or CHIP coverage?

You will need to apply for a new coverage plan as soon as you receive a Medicaid or CHIP coverage termination notification from relevant agencies. To ensure you receive all the notifications regarding your enrollment status, contact your Medicaid or CHIP agency to see if they have your detailed contact information. You can also find the contact information of Medicaid or CHIP agencies according to each state by following this link.

Q9: Is the CMS’s announcement of temporary unwinding SEP applicable in all state-based Marketplaces (SBMs)?

The temporary unwinding SEP announced by the CMS does not apply to all state-based Marketplaces. State-based Marketplaces that have their own enrollment and eligibility platforms. However, these state-based Marketplaces can offer their customers their own special enrollment periods as directed by federal regulations. If you live in a state-based Marketplace and are losing your Medicaid or CHIP coverage, you should contact your SBM to find out if they are offering SEP. You can also ask them about what you should do next to get the benefit of their SEP. You can also find information about your state-based Marketplace by vising the following link.

The Wrap Up

Losing coverage after years can cause a great deal of confusion and make it difficult for people to buy a new health insurance plan. There are a lot of questions going around regarding this recent happening. However, the CMS has taken many steps to streamline this process and provided as much information as possible by using different platforms and tools to the public to make this process easier for them. The CMS has offered many flexibilities, such as introducing the unwinding period, no requirement of extra documentation, and modifications in HealthCare.gov to help people check their eligibility and apply for new coverage, among others.

Navigating all the options available to you can be difficult. Let us help you find the plan that fits your specific needs as well as your budget. Our services are free for you to use, and we have access to all the carriers and plans in your area. Call us today and let one of our licensed agents assist you.