SEPSEP (Special Enrollment Periods)

Typically, you can only purchase health insurance coverage through the Marketplace Exchange during the Open Enrollment Period. This lasts between November 1st and January 31st each year. However, there are some qualifying events that trigger Special Enrollment Periods, or SEPs. If you qualify for a SEP you can enroll in a Marketplace plan even if it is not Open Enrollment. This article will go over several different events that trigger SEPs.

Losing Job-Based Coverage

Many people receive health insurance coverage through their employer. However, there are certain events that can trigger a SEP during which you could enroll in a Marketplace plan. These events would include:

  • Employer stops offering health insurance coverage
  • Leaving your job that offered you coverage. This would include getting fired or leaving voluntarily.
  • The employer does not offer your qualifying coverage. This means that your employer does not offer a health insurance plan that is affordable and/or meets minimum value standards.
  • Your job-based plan expires at the end of the year and you choose not to renew.
  • Your former employer stops contributing to your temporary continuation of coverage (either COBRA or retiree coverage) and this change makes it so you have to pay the full cost of the plan.

It is important to note that if you voluntarily drop your coverage during the year, lose your coverage due to non-payment of premiums, or you end your COBRA enrollment outside of Open Enrollment, you would not qualify for a SEP.

Losing Coverage Through Self-Purchased Plan

If you purchased your own health coverage, there are certain events that would trigger a SEP and allow you to enroll in another plan outside of Open Enrollment. Some of these events are:

  • Your individual or Marketplace plan is discontinued
  • You lose eligibility for a student health plan
  • You lose edibility due to moving out of the plan service area
  • Your coverage ends in the middle of the year and you choose not to renew.

You would not be eligible for a SEP if you voluntarily drop coverage in the middle of the year, you lose coverage due to non-payment of premiums, or you lose coverage due to not providing the Marketplace with sufficient information to resolve any data matching issues.

Losing Medicaid or CHIP Eligibility

This SEP is pretty self-explanatory. If you lose your Medicaid eligibility, whether it’s due to a change in income or you become ineligible because you were on a pregnancy or medically needy plan, you become eligible to enroll in a new plan on the Marketplace. You also become eligible for a SEP if you age off of CHIP.

Losing Coverage Through a Family Member

If you rely on a family member to pay for your health insurance coverage and you lose coverage due to one of the below-listed reasons, you could be eligible for a SEP.

  • Turning 26 and losing eligibility to be on your parent’s plan
  • Losing job-based coverage through your family members employer
  • You lose your coverage through your spouse due to divorce or legal separation
  • Losing your coverage due to the death of a family member
  • You lose eligibility because you are no longer a dependent of your parent or guardian

Change in Household Size

If you have a change in your household size outside of Open Enrollment you could qualify for a SEP. Some changes that might trigger this would include:

  • Getting married
  • Having a baby, adopting a child, or fostering a child
  • Getting divorced or legally separated
  • Death of a person enrolled in your plan

Change in Residence

Moving is one of the most common SEP triggers. Some moving situations that might apply to you are:

  • Move into a new zip code or county
  • Move to the U.S. from a foreign country or U.S. territory
  • If you are a student and you move to or from where you attend school
  • If you are a seasonal worker and you move to or from the place to work to where you live
  • Moving to or from a shelter or other transitional home

Conclusion

There are many different situations that can trigger Special Enrollment Periods. The ones listed here are just a few. It is also important to keep in mind that there are time restrictions involved with each SEP. Meet with a Qualified Insurance Agent who can help you to apply for your SEP in the required time frame.

Have any other questions or want to schedule an appointment? You can contact us by clicking here.