QUESTION

Due to a natural disaster in my area I have moved and don’t know when or if I can return to my home. What should I do to maintain access to health care?

Individuals with no coverage | Open and Special Enrollment Periods
ANSWER

You would probably not qualify for a special enrollment period (SEP) based upon a move. According to administrative guidance, you must be living in the new marketplace service area AND have an “intent to reside” there, meaning you intend to stay in the new location. If you are in the new service area for a transitionary purpose, like to “attend a business matter, obtain medical care, or for personal pleasure,” you would not meet the “intent to reside” requirement. The guidance, however, does not address whether a move due to a natural disaster would qualify you for a SEP. Contact the marketplace and Marketplace Call Center (HealthCare.gov) at 1-800-318-2596 (TTY: 1-855-889-4325) and see if your particular circumstances will meet the SEP requirements. Note that to obtain a SEP due to a move, you must have had qualifying coverage at least one day in the 60 days prior to your move and you must provide verifying documents of your move and prior coverage to enroll into a marketplace plan.

If your dislocation from your home due to a natural disaster prevents you from enrolling into 2019 marketplace coverage during open enrollment, you may be eligible for a SEP due to “exceptional circumstances.” “Exceptional circumstances” are circumstances like a natural disaster that prevented you from enrolling into marketplace coverage during open enrollment. (CMS, FAQs on the Marketplace Residency Requirement and Special Enrollment Period due to a Permanent Move, Jan. 19, 2016; Special Enrollment Period (SEP) Overview for the Federally-facilitated (sic) Marketplace, July 2018).

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