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Now that the Open Enrollment window has closed for 2019, you may be wondering what your options are, if any, for enrolling in health benefits for the year.  While there are no extensions to Open Enrollment for latecomers, if you have experienced certain qualifying events leaving you in need of healthcare, you may be eligible for a Special Enrollment Period. 

Special Enrollment Period

A Special Enrollment Period (SEP) is the period outside of annual Open Enrollment when you can enroll in new healthcare benefits due to certain, specific qualifying events. After experiencing a qualifying event, there is usually a 60-day window for you to enroll in healthcare coverage.  If you do not enroll during this window, you will have to wait until the next Open Enrollment period to enroll in healthcare coverage.

Qualifying Events for Special Enrollment Periods

You may qualify for a Special Enrollment Period if you have experienced a change in your household size, a change in your residence, or a loss of eligible healthcare coverage.

Change in Household Size – If your household size has changed due to one of the following circumstances, you may be eligible for healthcare enrollment through an SEP:

  • Having a baby or adopting a child
  • Getting married
  • Placing a child in foster care
  • Divorce or legal separation that causes a loss of health coverage
  • Death of a household member

Change in Residence – If you or anyone in your household has changed residence, giving you access to new Marketplace plans as a result, you may qualify for an SEP.  A change in residence includes:

  • Moving to a new home in a new zip code or county
  • Moving from the US to a foreign country or US Territory
  • If you are a student, moving to or from the place you attend school
  • If you are a seasonal worker, moving to or from the place you both live and work
  • Moving to or from a shelter or other transitional housing

Loss of Eligible Coverage - If you or anyone in your household has lost eligible healthcare coverage in the last 60 days or expects to lose coverage within the next 60 days, you may qualify for an SEP.  Eligible healthcare coverage includes:

  • Coverage through an employer or a sponsor’s employer if you are a dependent.
  • Medicaid or CHIP
  • Medicare
  • Individual or group health plan coverage that ends during the year
  • Coverage under your parent’s health plan.  If you turn 26, making you ineligible receive health benefits through a parent’s health plan, you can qualify for a Special Enrollment Period. 

A few other circumstances which allow you to qualify for a Special Enrollment Period include:

  • Losing eligibility for Medicaid or CHIP
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

If You Think You Qualify, What's Next?

In order to enroll in a new health plan, you must apply through your local healthcare marketplace.  After you apply through the Marketplace, you may be required to provide documents proving your eligibility.  You will be prompted to either upload these documents online or mail copies before you can make your first premium payment and begin using your new coverage.  The healthcare coverage will begin after your first payment is made. 

We Can Help!

If you believe you qualify for a Special Enrollment Period, let RedQuote help.  Redquote is a team of passionate and experienced healthcare advisors ready to help you navigate the healthcare exchange. We will help you determine your eligibility for an SEP, Medicaid or CHIP, and help you find a plan through the Marketplace.  Don’t hesitate to call RedQuote today.

Published Jan 4, 2019.

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