To enroll in a major medical health plan outside of the allotted nation-wide 6-week period you must have a valid qualifying life event to apply for during a special enrollment period. The time period varies for differing situations, you may have 60 days before or 60 days following the event to enroll in a plan. If you miss your Special Enrollment Period window, you will have to wait until the next Open Enrollment Period to apply. But let’s look at the applicable life events for a special enrollment period.
Qualifying Life Events
If you were previously covered by a major medical plan and you lose the plan due to no fault of your own, you may qualify for a special enrollment period:
Changes in household
- Recently married
- Had a baby, adopted a child, or placed a child in foster care
- Recently divorced
- Death of a member on your current Marketplace plan which result in you no longer being eligible for your current health plan
Changes in residence
- Moving to a new home in a new county or zip code
- Moving to the U.S. from a foreign country or United States territory
- If you’re a student, moving to or from the place you attend school
- If you’re a seasonal worker, moving to or from the place you both live and work
- Moving to or from a shelter or other transitional housing
Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period. However, if you are moving within the United States, you must have had a major medical plan within 60 days of your move.
Loss of health insurance
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.
- Loss of job-based health coverage (even if you quit)
- Losing Cobra
- If a family member who had you on their plan loses insurance
- You lose eligibility for a student health plan
- You lose eligibility for a plan because you no longer live in the plan’s service area
- You turn 26 and can no longer be on a parent’s health plan
Important: Losing individual coverage doesn’t qualify you for a Special Enrollment Period if you voluntarily drop coverage, if you lose coverage because you didn’t pay your premiums, or if you lose Marketplace coverage because you didn’t provide required documentation when the Marketplace asked for more information.
An employer offer to help with the cost of coverage
You may qualify for a Special Enrollment Period if you or anyone in your household newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days OR expects to in the next 60 days.
Note: Your employer may refer to an individual coverage HRA by a different name, like the acronym “ICHRA.”
Generally, you’ll need to apply for and enroll in individual health insurance before your individual coverage HRA or QSEHRA starts. However, your employer may offer different options for when your individual coverage HRA or QSEHRA can start so you have more time to enroll. Contact them or check the notice you got from your employer for more information. If you’re currently enrolled in a Marketplace plan with savings, these savings may change because of the help you get through a job. Get more information on how your savings may change if you have an individual coverage HRA or QSEHRA offer.
More qualifying changes
- Becoming a US citizen
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member
- Leaving incarceration
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