Simone Lawson
There are certain life events that allow individuals to sign up for health insurance outside of the yearly Open Enrollment Period. These life events include losing health coverage, moving, getting married, having a baby, or adopting a child. This is called a Special Enrollment Period, and individuals may qualify if they have experienced specific changes in their lives or if their household income is below a certain amount. It is important to note that not all life events qualify for a Special Enrollment Period, and individuals may have other coverage options outside of the Open Enrollment Period.
| Characteristics | Values |
|---|---|
| Qualifying life events | Loss of health coverage, moving, getting married, having a baby, adopting a child, decrease in household income, death, divorce, job loss, birth |
| Qualifying health coverage | Marketplace plans, Medicare, Medicaid, CHIP, job-based plans, individual plans |
| Special cases | American Indians and Alaskan Natives, subsidy-eligible applicants, union workers who lost health insurance due to a strike, lockout, or labor dispute |
| Enrollment options | Special Enrollment Period, private plans, Basic Health Programs, The ConnectorCare program, Covered Connecticut program, Apple Health |
| Limitations | May not be able to switch to a different metal plan during SEP, may not qualify for Apple Health, most health plans sold outside Open Enrollment don't count as qualifying health coverage |
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What You'll Learn
Qualifying life events
If you missed the Open Enrollment Period, you can still sign up for health insurance if you qualify for a Special Enrollment Period. This is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you've experienced certain qualifying life events or QLEs.
Additionally, certain life events such as job loss, birth, adoption, or marriage may qualify you for a Special Enrollment Period. If someone on your Marketplace plan dies, causing you to lose your current health plan, you will also qualify. In some cases, divorce or legal separation that results in a loss of health insurance may also be considered a qualifying life event.
It's important to note that not all life events qualify for a Special Enrollment Period. For instance, divorce or legal separation without losing health coverage does not qualify. Furthermore, if you choose to voluntarily drop your current coverage, you will generally not qualify for a Special Enrollment Period unless you also experience a decrease in household income or a change in your previous coverage that makes you eligible for savings on a Marketplace plan.
To enroll during a Special Enrollment Period, you may be required to provide proof of the qualifying life event. The rules for Special Enrollment Periods may vary depending on the state and the specific health insurance plan.
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Special Enrollment Period
Qualifying life events for a SEP vary based on the specific circumstances and location. For example, in Washington, qualifying life events include job loss, birth, adoption, and marriage. In other states, moving to the U.S. from a foreign country or U.S. territory may qualify individuals for a SEP, while moving solely for medical treatment or vacation does not. Additionally, individuals who lose their health or dental insurance due to a strike, lockout, or labour dispute may be eligible for a SEP.
Losing health coverage is a common qualifying life event for a SEP. This includes losing individual health coverage or Medicaid/Children's Health Insurance Program (CHIP) coverage. Losing eligibility for a student health plan, no longer living in the plan's service area, or choosing not to renew a plan that ends in the middle of the calendar year can also qualify individuals for a SEP. However, it is important to note that losing coverage due to a failure to provide required documents does not qualify for a SEP.
American Indians and Alaska Natives can enroll in exchange plans year-round and change their plans once a month. Additionally, individuals with a household income below a certain level may qualify for a SEP, as subsidy-eligible applicants whose household income does not exceed 150% of the federal poverty level can enroll year-round.
It is important to note that the availability of SEPs may vary based on state-run exchanges, and individuals should be prepared to provide proof of qualifying life events and understand the limitations of changing coverage during a SEP.
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Private health plans
You can find these private plans through some insurance companies, agents, brokers, and online health insurance sellers. Insurance companies can tell you if a particular plan counts as minimum essential coverage.
In some cases, you may qualify for a Special Enrollment Period (SEP) if you have experienced certain qualifying life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child. You may also qualify if your household income is below a certain amount. During the Special Enrollment Period, you may be eligible for a premium tax credit and a cost-sharing reduction to help lower your premium and total out-of-pocket costs.
Additionally, short-term plans are available in some states, with a policy duration of up to four months. However, when the short-term plan ends, you will no longer have access to an ACA-compliant plan until the next open enrollment period.
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State-run exchanges
One of the key advantages of state-run exchanges is their ability to provide enhanced consumer protections and benefits. States have the flexibility to establish additional standards for insurance carriers, ensuring that plans offered on the exchange meet specific criteria for quality and consumer protection. Some states may require insurers to provide certain essential health benefits or adhere to stricter network adequacy standards, resulting in more comprehensive and accessible care for enrollees.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to eligible low-income adults, families, children, pregnant women, the elderly, and people with disabilities. In all states, Medicaid provides coverage for low-income people, including families and children, pregnant women, the elderly, and people with disabilities. Some states have expanded their Medicaid programs to cover adults below a certain income level.
To apply for Medicaid and CHIP, you must create an account with the Health Insurance Marketplace and complete an application. If it appears that anyone in your household qualifies for Medicaid or CHIP, your information will be forwarded to your state agency, which will contact you about enrollment. Your state may review your information annually to determine ongoing eligibility for Medicaid. If they require additional information, they will reach out to discuss renewing your coverage.
It is important to note that not all medical providers accept Medicaid. Therefore, it is advisable to locate a Medicaid or CHIP medical provider by checking with your state's Medicaid agency. Additionally, each state's CHIP program is unique, and qualification criteria may differ. While CHIP generally covers children and pregnant women, specific financial and non-financial criteria must be met. For instance, CHIP beneficiaries must be residents of the state in which they are receiving CHIP and must meet certain citizenship requirements.
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Frequently asked questions
A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance.
You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
Qualifying life events include job loss, birth, adoption, marriage, divorce, and more.
You can find health plans outside of the Open Enrollment Period through some insurance companies, agents, brokers, and online health insurance sellers.
