Normally, you have to enroll in your Healthcare Marketplace insurance plan during the open enrollment period, which is usually from early November to late January. However, there are some circumstances that may allow you to qualify for a special enrollment period (SEP) and provide you with the opportunity to choose and enroll in health insurance coverage at a time that is different from open enrollment.
What Are the Events that Allow You to Qualify for an SEP?
Certain, life-altering events can allow you to qualify for your own SEP. These can include
- Getting married
- Having a baby
- Adopting a child
- This can also include gaining or becoming a dependent through foster care, child support, or another type of court order.
- This usually qualifies as a life event when an individual loses a dependent or can no longer be considered a dependent because of a death in the family.
- Both divorce and legal separation can be qualifying events if you lose or are no longer considered a dependent because of this event.
These life events are serious and can drastically change the situation an individual is dealing with on a day-to-day basis. Therefore, it is important for an SEP to open up for those in one or more of these situations so they can find a health insurance plan that works for their current needs.
How Else Can You Qualify for an SEP?
There are actually other ways through which you can qualify for an SEP. For example, if an individual suddenly loses their health coverage, they may qualify for an SEP during which they can find a new plan. Some other ways you might qualify for an SEP are if you
- Become ineligible for Medicaid or the Children’s Health Insurance Program (CHIP)
- Gain membership in a Native American tribe that is federally recognized
- Receive status as an Alaskan Native
- Become a U.S. citizen and, as a result, become eligible for coverage through the Health Insurance Marketplace
- Start or end your service with AmeriCorps VISTA
- Are released from incarceration
- Experience spousal abandonment or domestic abuse
- Experience an error in your plan information through the Healthcare Marketplace
All of these special circumstances could also allow you to qualify for an SEP. But how long do these periods last and how do you apply?
What Do I Need to Know About Applying for an SEP?
In most cases, you have about 60 days from when the qualifying event making you eligible for an SEP occurred to enroll in a new plan through the Health Insurance Marketplace. This means it is important to apply for your new plan as quickly as possible, or otherwise, your SEP might expire and you will have to wait until open enrollment to choose a plan.
When you are ready to apply for health coverage during your SEP, use these easy steps in order to do so.
- Go to the Healthcare.gov website. Here you will be encouraged to answer a number of questions in order to ensure that you will qualify for an SEP as a result of a life change or another circumstance.
- If you are still unsure about whether or not you will fully qualify for this enrollment period, you can call the Marketplace Call Center in order to speak with an expert about your circumstances.
- You can also just create an account through the website if you are certain you qualify for this SEP.
- If you do qualify for an SEP, you will be able to apply for a health insurance plan and find the coverage you need through whichever medium is most comfortable for you: over the phone, through the website, or even through a local organization where you can speak to someone face to face.
If you do decide to speak with someone about your SEP qualifications, make sure you have all the information they will be likely to ask for (including birth certificates, death certificates, proof of relocation, etc.).
What Happens If I Am Denied an SEP?
Under certain circumstances, you may apply for an SEP and be denied. If this is the case, you can file an appeal in order to get the SEP. If the denial is reversed through the appeals process, you can gain coverage back to the point where your SEP was originally denied.
Appeal forms for each state and information about how to file an appeal can be found at Healthcare.gov.