GEAR Newsletter: May, 2016



As you may have heard, the uninsured rate has fallen to a historic low. This is due in large part all of YOUR hard work helping people enroll in health insurance. 

All about SEPs


While much of the open enrollment heavy lifting has died down, we know that there is still a lot of work to be done outside of open enrollment, especially around Special Enrollment Periods. As we have mentioned before, Centers for Medicare and Medicaid Services (CMS) has tightened the documentation requirements for SEPs, which may cause consumers to have problems enrolling. If you have encountered this, we want to hear from you! Please reach out to Pranay if you come across any instances of documentation requirements preventing someone from enrolling during an SEP. CMS is still accepting comments on the new SEP rules, so it is important to hear from enrollment assisters about what you are experiencing. If we do get feedback from GEAR members, Families USA would like to hear from us and incorporate that feedback as they draft their own comments.

Another SEP change going into effect in July is the “permanent move” requirements. To be eligible for this SEP, consumers must have had minimum essential coverage for at least one day in the 60 days prior to their move. This is a change from the current rule that allows any consumer to enroll in coverage if they move to a new service area, regardless of prior coverage. Exceptions apply for consumers who are moving from another country, were previously incarcerated, or are moving from a non-expansion state and are newly eligible for tax credits.

This updated SEP fact sheet from CMS details the new guidelines.

Resource Highlight – Rural Area Fast Facts from CMS


Do you work in rural Georgia? Much of the state is considered rural and these areas come with unique challenges for outreach and enrollment. Consumers in rural areas may be hard to reach, face limited choice and access to care, have concerns over affordability, face barriers to communication, and lack transportation. CMS has released a fact sheet to help address the needs that consumers in rural areas may have.

New Marketplace Resources

When a Bill Becomes a Coverage Appeal: A Basic Overview
Webinar – Families USA

Healthcare Eligibility for Justice-Involved Individuals
In the Loop