Keep up with today’s trending topics: VISIT THE INSIGHT CENTER

Individual Health: Know The Special Enrollment Period Qualifiers

Employee Benefits, Personal Lines

Since the 2017 Open Enrollment Period is over, you can now enroll in or change your Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.

Life changes that may qualify a Special Enrollment Period:

LOSING HEALTH INSURANCE

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.  Coverage losses that may qualify you for a Special Enrollment Period:

Loss of job-based coverage, qualifying conditions:

  • Your employer stops offering coverage.
  • You leave a job where you had health coverage (even if you left your job by choice or were fired).
  • You have a reduction in work hours that causes you to lose your job-based plan.
  • Your job-based plan doesn’t offer qualifying health coverage and as a result you become newly eligible for a premium tax credit. Most job-based plans count as qualifying health coverage. To find out if your employer’s coverage meets the standards, ask your employer to complete the Employer Coverage Tool (PDF).
  • Your job-based health plan is ending for the year and you choose not to renew it. Note: If the plan is affordable and meets minimum value standards, you can buy Marketplace insurance but won’t qualify for a premium tax credit or other savings.
  • Your former employer stops contributing to your retirement coverage, requiring you to pay full cost.

You DON’T qualify for a Special Enrollment Period when losing job-base coverage if:

  • You voluntarily drop your job-based coverage during your coverage year while still working for your employer.
  • You lose your job-based coverage because you didn’t pay your premium.

Loss of COBRA Coverage, qualifying conditions:

  • Your COBRA coverage runs out.
  • Your former employer stops contributing to your COBRA coverage, requiring you to pay the full cost.

You DON’T qualify for a Special Enrollment Period when losing COBRA coverage if:

  • You decide to end COBRA early (and are paying the full cost yourself).
  • You lose your COBRA coverage because you didn’t pay your premiums.

Note: You don’t need a Special Enrollment Period if you voluntarily end COBRA early during a Marketplace Open Enrollment Period. You can drop your COBRA plan and enroll in a Marketplace plan at that time.

Loss of individual health coverage, qualifying conditions:

  • Your individual plan or your Marketplace plan is discontinued (no longer exists).
  • You lose eligibility for a student health plan.
  • You lose eligibility for a plan because you no longer live in the plan’s service area.
  • Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.

You DON’T qualify for a Special Enrollment Period when losing individual coverage if:

Loss of eligibility for Medicaid or CHIP, qualifying conditions:

  • You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.
  • Your child ages off CHIP.

Loss of eligibility for Medicare, qualifying condition:

  • You become no longer eligible for premium-free Medicare Part A

You DON’T qualify for a Special Enrollment Period when losing Medicare eligibility if:

  • You lose Medicare Part A because you didn’t pay your Medicare premium.
  • You lose Medicare Parts B, C, or D only.

Loss of coverage through a family member, qualifying conditions:

  • You turn 26 (or the maximum dependent age for your state) and can no longer be on a parent’s health plan.
  • You lose job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for dependents.
  • You lose health coverage through a spouse due to a divorce or legal separation.
  • You lose health coverage due to the death of a family member.
  • You lose health coverage through a parent or guardian because you’re no longer a dependent.

You DON’T qualify for a Special Enrollment Period when losing coverage through a family member if:

  • You voluntarily drop coverage.
  • You or your family member lose coverage because you didn’t pay your premiums.

CHANGE IN HOUSEHOLD SIZE

A change in household size (occurring in the past 60 days) may qualify you for a Special Enrollment Period.

  • Marriage. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Birth or adoption of a child, or placing a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
  • Divorced or legal separation resulting in loss of health insurance. (Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.)
  • Death. Someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

CHANGE IN RESIDENCE

A change in residence may qualify you for a Special Enrollment Period.

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or United States territory
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

You DON’T qualify for a Special Enrollment Period due to a change in residence if:

  • The move is only for medical treatment
  • The household is staying somewhere on an extended vacation

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

______________________

The information in this post was obtained from the healthcare.gov website. 
If you’d like further guidance on Special Enrollment Period qualification as it pertains to your specific situation, contact Virginia Van Haren.

Back to Insight Center