Close to 1 million new consumers selected a plan through HealthCare.gov because they qualified for a special enrollment period, according to a report from CMS.
Close to 1 million new consumers selected a plan through HealthCare.gov because they qualified for a special enrollment period (SEP), according to a report from CMS. Consumers qualify for a SEP if they lose their health coverage, lose Medicaid eligibility, have a change in family status (such as marriage or the birth of a child), or other exceptional circumstances.
The CMS snapshot includes SEP coverage information from February 23 to June 30 for the 37 states with federally facilitated marketplaces, state partnership marketplaces, and supported state-based marketplaces.
“Life changes are often impossible to predict, but access to affordable and quality healthcare coverage should never be,” Kevin Counihan, chief executive officer of the Health Insurance Marketplace, said in a statement. "So far this year, nearly 950,000 people have gained the peace of mind that comes with access to coverage by taking advantage of a special enrollment period, providing us with further evidence that the Health Insurance Marketplace is working for America’s families. We want people to know that if they lose a job, get married, have a baby, or experience other life changes, we’re here to help them find coverage they can afford.”
Half of SEP plan selections were for the loss of health coverage and 19% because consumers had become ineligible for Medicaid. In addition, prior to the beginning of the tax season SEP, plan selections average more than 5000 a day and daily SEP activity increased gradually during tax season. Overall, 15% of SEP plan selections were due to the tax season SEP.
160,828 during the time period of February 23 to June 30.
Florida had the most SEP plan selections with a total of
"SEPs are helping consumers avoid gaps in health insurance coverage by providing a valuable link to affordable health insurance options," the CMS report concluded.
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
Read More
AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
Listen
Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
Listen