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Special Enrollment Period Refresher!

April 11, 2016

by April Holgate

Typically you can only apply for marketplace health coverage during open enrollment, however, there are exceptions that make up Special Enrollment Periods(SEP). These SEPs are generally connected to life changes that will allow you a set time period to enroll in health coverage, usually it is 60 days before and for 60 days after the event. The major SEPs can be broken up into 4 categories:  Moving out of a coverage area, change in employment, change in tax household and change in marital status. Let’s take a look at what each one means to you the consumer.

Moving out of Coverage Area, is anytime you are moving your permanent residence to a location that is not covered by your insurance provider. This may be a move to a different city, state or county. It needs to be a permanent move, not just for a few days/weeks/months.

Change in Employment, this is when you lose your job, start a new job or your employer no longer offers coverage. If you had coverage through your work and that job is ending, you have two options. You will be offered the option of continuing that coverage through COBRA, paying the full premium yourself each month. This is often a very costly option. The other choice is to apply for coverage through the Marketplace, where you may qualify for Medicaid or tax credits to help pay your premium. You can also apply if you are changing jobs and the new employer does not offer health coverage or has coverage that is too expensive, more than 9.5% of your gross income.

Change in Tax household, this is when you gain or lose a dependent. Basically, if you have a baby, adopt or add someone new to your home, that you will claim on your taxes this qualifies your for an SEP. This also applies if you lose a dependent, such as someone passing away, your child is removed from the home or turns 26 requiring them to get their own health coverage. You could also fall under this category if you have an increase in income that causes you to lose Medicaid Coverage.

Finally a Change in Marital Status, this is either getting married, separated or divorced. When you get married, if neither of you have an employer that offers affordable coverage, you would be able to apply for a plan through the Marketplace. If you are getting divorced or separated, you can only apply if the divorce/separation causes you to lose coverage. The event itself does not qualify you for a SEP, only a loss of coverage due to the event.

There are a few other key events that will give you an SEP. Becoming a US citizen or gaining a green card, being release from jail or prison, children going into or returning home from foster care, or if your COBRA coverage runs out.

You would not qualify for an SEP if you cancel your coverage or lose coverage because you are not paying your premiums.

With these SEPs it is important to apply for coverage in a timely manner, 60 days goes by very quickly. You will also want to reduce any gap in coverage that may occur. You may also be asked to provide proof of your SEP by sending in documents that verify the event. It is very important to stay on top of these changes and opportunities to gain coverage when they happen. Otherwise, you would have to wait for open enrollment and risk paying a penalty come tax time.

 

If you need help enrolling in an SEP or have questions about if you qualify please call our statewide helpline at 1-877-570-3642.