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How Do Special Enrollment Periods Work?


How Do Special Enrollment Periods Work?

Policy Scout
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Towards the end of the year, employers and the Healthcare marketplace allow individuals and families to apply for a healthcare plan. This enrollment period typically begins in the beginning of November and lasts through the middle of December. After the enrollment period closes, you will remain with your healthcare coverage selection until the next year.

However, there are also special enrollment periods that allow you to make changes to your current healthcare coverage.

What is a Qualifying Event?

You may be eligible to apply for healthcare using a special enrollment period if you lose your current health coverage or a qualifying event. Some of the most common reasons you may qualify for a special enrollment period include:

Loss of Current Health Insurance

There are various reasons you may lose your current health insurance, such as losing coverage because you left or were laid off from your employer. You may also become ineligible for Medicare, Medicaid, or CHIP.

Household and Family Changes

If you get married, have a child, adopt a child, or get divorced, you may qualify for a special enrollment period.

Dependents that come of age and wish to purchase their own health insurance will also allow you to apply for a special enrollment period.

Please note that you must apply for a special enrollment period and choose health coverage within 60 days.

Residential Changes

If you move to another zip code, or even if you're a seasonal worker, you may qualify for a special enrollment period.

Please note that you must prove that you had existing health coverage for at least one day within a 60-day period before your move.

Additional Qualifying Changes

There are a number of additional circumstances that qualify as a changing life event, such as becoming a citizen. Please view the complete list of qualifying changes for a special enrollment period.

Life Changes that do not Qualify

There may be other changes that you think might qualify for a special enrollment period, but do not. However, one exception is if your current health insurance coverage is not available under the new position.

How To Use a Special Enrollment Period

If you are currently employed, talk to your employer and explain the circumstances regarding your qualifying life change.

Otherwise, you can easily apply for health insurance through an online insurance provider. Remember, you must apply within 60 days of your life-changing event.

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When you file for a special enrollment period, you will be required to answer questions regarding the qualifying life change.  Afterward, you will be able to view and select a new health plan that suits your needs and budget.

If for some reason you are turned down for a special enrollment period, you can file an appeal. There may also be an instance that prevented you from applying for the special enrollment period. You can still qualify to apply if you can provide proof that you lived in the area of a FEMA designated incident.

When Does the New Health Insurance Coverage Start?

After applying for health insurance, your coverage will  start on the first of the next month. In some cases, such as the event of a death or birth, it may be possible to start coverage mid-month.

Applying for health coverage during a special enrollment period can be confusing. But with these tips, you can get covered with no headaches.


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