Health Insurance

Marketplace Special Enrollment Period – SEP

The open enrollment period for getting government-subsidized health insurance is between November 1st and December 15th every year. If you don’t enroll and get coverage by this deadline, you can’t get subsidized health coverage.

The only way to get around this is to qualify for the Special Enrollment Period. You can only qualify for the Special Enrollment Period if certain life events happened that prevented you from enrolling in subsidized health coverage or resulted in losing your insurance. These outcomes can happen only due to certain life events which all are covered under the Special Enrollment Period.

To be eligible for the Special Enrollment Period, the following life events must have happened in the past 60 days. These life events not only include you but any other member of your household.

Individually

Having a Child

If you or anyone in your household had a baby, adopted a child, or placed a child for foster care, you may qualify for the Special Enrollment Period. If so, your coverage can start immediately even if you apply to get subsidized coverage after 60 days of event happening.

Marriage

Those who recently got married can get a plan with their spouse. This oftentimes saves money individually. Since you will qualify for the SEP for getting married, you can enroll in subsidized health insurance even after the open enrollment period ends. Simply, pick a plan by the last day of the month and the coverage will start the first day of the next month.

Death

If someone on your Marketplace plan dies and you lose coverage as a result of that, you qualify for the SEP.

Divorce

Losing coverage because of a divorce or legal separation qualifies you for the SEP. But if you divorce or separate legally but keep your health insurance, you won’t qualify for the SEP.

Losing Health Insurance

Loss of health insurance oftentimes qualify individuals for the Special Enrollment Period. Here are a few examples of what can qualify you for the Special Enrollment Period.

  • Losing eligibility for Medicaid or CHIP
  • Losing coverage at work
  • Losing eligibility for Medicare
  • Losing health coverage you bought for yourself

Residence Change

Certain household moves qualify families for the Special Enrollment Period. For the household move to qualify for the SEP, the new location must be in a new ZIP code or county. However, if you’re a seasonal worker, moving from or to the place you live and work qualifies you for the SEP. On the other hand, the same goes for students who are moving from or to school. In addition to these, moving from or to a shelter or transitional housing can make individuals qualify for the Special Enrollment Period.

However, all individuals must prove that they had health insurance for at least one or more 60 days prior to the move. Those who are moving from a U.S. territory or a foreign country aren’t required to show this proof.

Other Qualifying Points

  • Recently becoming a U.S. citizen, thus, qualifying for Marketplace coverage
  • Leaving incarceration
  • Gaining membership in a federally recognized tribe or status as an ANCSA (Alaska Native Claims Settlement Act)
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member.

Deborah Ann

Deborah writes everything from federal tax law to local governments. Her writings cover a broad range of government topics. With a little bit of seriousness to the words, everything is simplified to Futufan readers.
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