Open Enrollment for Individual Health Insurance Coverage has ended 01/31/2017 – What are the ways you can qualify for coverage during the lock out period?

What is an Individual Special Enrollment Period?

Individuals who experience certain life events may qualify for a Special Enrollment Period (SEP) outside of the annual Open Enrollment Period allowing them to enroll in a health plan and obtain coverage any time of the year. During a Special Enrollment Period, individuals may enroll in a plan on or off the Health Insurance Marketplace or change from one Qualified Health Plan to another. The SEP lasts 60 days from the date of a triggering event for qualified individuals or their dependents.

Who qualifies for a Special Enrollment Period?

In order to be eligible for a SEP, an individual must experience a qualifying life event. Qualifying life events are significant changes in your life which cause you to lose your health coverage or have a change in family status or residency.

What are Examples of Qualifying Life Events?

A change in your household size:

  • Getting married
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Death of family member (causing you to lose eligibility in your current plan)

Losing your health coverage:

  • Losing job-based coverage for any reason, including resigning, getting laid off, or getting fired
  • Expiration of COBRA coverage
  • Losing coverage under your parents’ plan at age 26
  • Getting divorced or legally separated (resulting in loss of coverage)
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)

Note: Losing coverage that doesn’t qualify as minimum essential coverage doesn’t qualify you for a Special Enrollment Period.

A change in circumstance:

  • Permanently moving outside your plan’s coverage area
  • A change in income (affecting eligibility for premium tax credits or cost-sharing reductions)

A change in status:

  • Release from jail or prison

How soon can you get coverage started during a Special Enrollment Period?

Most qualifying life events allow you to enroll and begin coverage the first day of the next month if you enroll by the 15th of the month. If you enroll after the 15th of the month, your coverage will begin the first day of the following month. This works the same as it does during the Open Enrollment Period. However, there are a few exceptions which allow same-day effective coverage to begin:

  • Birth of child
  • Adoption of child

How long does a Special Enrollment Period last?

A Special Enrollment Period is triggered by a qualifying life event and typically lasts for 60 days. However, the Special Enrollment Period may vary based on the type of qualifying life event.

What is a hardship exemption?

A hardship exemption is an exceptional circumstance, and it triggers a 60-day Special Enrollment Period. Examples of exceptional circumstances are unexpected hospitalizations, natural disasters, or temporary cognitive disability. 

Gaining citizenship or lawful presence in the U.S.

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