Missed individual health open enrollment? You may still have options. A Special Enrollment Period may allow you to enroll in Marketplace health coverage outside the annual Open Enrollment Period after certain qualifying life events, such as losing eligible coverage, moving, getting married, or having a child.
M3 Elevate is here to guide you through the Special Enrollment Period based on your specific situation. Read on to learn which individuals do and do not qualify based on life events and changes.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) may allow you to enroll in individual health insurance outside the annual Open Enrollment Period after certain qualifying life events. These can include losing qualifying health coverage, getting married, having or adopting a child, or making certain moves. Eligibility, enrollment timing, and documentation requirements can vary based on your situation.
Frequently asked questions About Special Enrollment Periods.
Life events that qualify under the Special Enrollment Period
Certain changes in your life or health coverage may make you eligible for a Special Enrollment Period. Common qualifying life events fall into four categories. Eligibility depends on the specific circumstances, so the examples below aren’t an exhaustive list.
Losing Health Coverage
Losing certain types of health coverage may qualify you for a Special Enrollment Period. Examples can include:
- Losing job-based health coverage
- Losing coverage through a family member’s employer
- Turning 26 and losing coverage through a parent’s health plan
- Losing qualifying individual or student health coverage
- Losing eligibility for certain government health coverage
- Exhausting COBRA coverage
Keep in mind: Not every loss of coverage qualifies. For example, voluntarily dropping certain coverage or losing coverage because premiums weren’t paid may not qualify you for a Special Enrollment Period. Eligibility depends on the circumstances surrounding the loss of coverage.
Changes in Your Household
Certain changes to your household may make you eligible for a Special Enrollment Period, including:
- Getting married
- Having a baby
- Adopting a child
- Getting divorced or legally separated when the change results in a loss of health coverage
- Experiencing a death in your household when it results in a loss of your current health coverage
Because eligibility can depend on how the household change affects your coverage, the event itself does not always guarantee a Special Enrollment Period.
Changes in Residence
Certain moves may qualify you for a Special Enrollment Period, including:
- Moving to a new ZIP code or county
- Moving to or from the place you attend school
- Certain moves associated with seasonal work
- Moving to or from a shelter or other transitional housing
What may not qualify: Moving solely for medical treatment or temporarily staying somewhere for vacation generally does not qualify as an eligible move.
Other Qualifying Life Events
Other circumstances may also make you eligible for a Special Enrollment Period. These can include certain changes in citizenship or immigration status, leaving incarceration, changes involving membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act corporation shareholder, and other qualifying circumstances.
Special Enrollment Period rules vary depending on the event. If you’ve recently experienced a major change in your coverage, household, or circumstances, confirm your eligibility and enrollment requirements before making coverage decisions.
Not sure if your life event qualifies? M3 Elevate can help you understand your individual health insurance options and determine your next steps.
What Happens After You Apply for a Special Enrollment Period?
If your special enrollment period is confirmed
If the Marketplace confirms your Special Enrollment Period, it will send your enrollment information to the health insurance plan you selected. You’ll then need to pay your first premium directly to the insurance company. Your coverage will not begin until the first premium is paid.
If your special enrollment period is not confirmed
If the Marketplace can’t confirm your Special Enrollment Period based on the documents you submit, you’ll receive a notice explaining the issue. You may be able to submit additional documentation to verify your qualifying life event.
Not sure whether you qualify? M3 Elevate can help you understand your individual health insurance options and determine the next steps based on your circumstances. For further guidance, connect with an M3 Elevate Client Executive.
Explore More Individual Health Insights
Find articles, updates, and resources to help you stay informed about Individual Health coverage and enrollment.
