What is a Special Enrollment Period (SEP)

Once Open Enrollment Period (OEP) has closed for every state the opportunity to qualify for a Special Enrollment Period opens. A person is eligible for a Special Enrollment period only if they experience a qualifying event. The White House recently announced a Special Enrollment Period from Feb 15, 2021 through May 15, 2021 for the ACA marketplace. State specific marketplaces may vary in start dates for this recently announced Special Enrollment Period.

Remember that someone is only eligible for a Special Enrollment Period 60 days before or after the qualifying event. If the time frame is missed he/she seeking coverage may have to wait until the following Open Enrollment Period. It is important to note that Medicaid or the Children’s Health Insurance Program (CHIP) enrollment is possible year-round.

If a person wants to verify their eligibility for a Special Enrollment Period they can use this HealthCare.gov Screener. The screener will either lead to a questionnaire or direct a person to their state’s respective marketplace for more information. Or you may contact us and we can answer any questions or concerns you may have.

Qualifying Events

Now we will cover the examples of qualifying events in order to be eligible for a special enrollment period. The following potential qualifying events must have occurred in the last 60 days:

  • Marriage
  • Loss of job or income due to the COVID-19 pandemic
  • Had a baby, adopted a child, or placed a child for foster care
  • Change of household size
  • Divorce or legal separation
  • Death of someone in marketplace plan
  • Moving to new ZIP code or county
  • Moving to the U.S. from abroad or a U.S. territory
  • Student moving from educational institution
  • Seasonal worker moving 
  • If a person moves to a shelter or any type of transitional housing
  • Losing job-based coverage
  • Losing coverage for a previously purchased policy
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program
  • Losing eligibility for Medicare
  • Losing coverage due to turning 26 years old 
  • Released from Jail or Prison
  • Gained citizenship or lawful presence

These are just some of the possible qualifying events to be eligible for a Special Enrollment Period. There are other various complex events that may justify eligibility for a Special Enrollment Period. It is always important to verify eligibility or reach out for help from a qualified individual.

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