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What is a special enrollment period?

Written by: Gabrielle Smith
September 7, 2021 at 8:39 AM

Signing up for health insurance isn’t something you can do whenever you want. When the Affordable Care Act went into effect, the time between November and January was dedicated as the only time Americans can sign up for health insurance. This time period is known as “open enrollment,” and keeps people from signing up for an insurance plan only when they get sick or injured.

However, what if you need to sign up for health insurance during other parts of the year, like when you lose employer-sponsored coverage, age out of a parent’s plan, or move to a new state? Cases like these are when “special enrollment periods” come in handy.

In this article we’ll explain in more detail what a special enrollment period is, what life events qualify you for one, and what to do once you do qualify.

What is a special enrollment period?

A special enrollment period is a time when you’re allowed to make changes to your health insurance plan even though it’s not an open enrollment period as defined by the Affordable Care Act (ACA).

Certain qualifying events will trigger a special enrollment period, allowing you to make changes to your health coverage for a certain period of time after the triggering event. (More on those in the next section).

Generally speaking, you’ll have 60 days following the event to enroll in a new health plan through the federal or state marketplace. Keep in mind, you’re eligible to enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time.

If you don’t make the necessary changes to your health insurance during the special enrollment period, you’ll have to wait until the next open enrollment period to make any changes.

How do I know if I qualify for a special enrollment period?

In order to qualify for a special enrollment period, you need to have a qualifying life event happen that would cause needed changes to be made to your health coverage.

There are four basic types of qualifying events:

  1. Loss of health coverage
    1. Ex: Losing employer-sponsored coverage, losing eligibility for Medicaid or CHIP, or losing coverage through a family member
  2. Offer of new health benefit
    1. Ex: Being offered an HRA or other employer-sponsored coverage
  3. Changes in household
    1. Ex: Getting married, having a baby, or losing a loved one
  4. Changes in residence
    1. Ex: Moving to a new zip code, moving to the U.S. from another country, or moving to or from the place you both live and work (if you’re a seasonal worker)

Having a qualifying life event isn’t the only way you can qualify for a special enrollment period. Other circumstances that can allow you to make changes to your health coverage include experiencing an enrollment or policy information display error, gaining or becoming a dependent due to a child-support, or getting an appeal decision that’s in your favor.

Learn more about qualifying life events in our article

What do I do if I qualify for a special enrollment period?

If you’ve experienced one of the qualifying events listed above, you’re ready to apply for a special enrollment period. You can do this either through Healthcare.gov or your state exchange.

Your application will be different depending on whether you’ve experienced a qualifying life event, or if you’ve had another special circumstance that will affect your health coverage.

If you’ve experienced a qualifying life event, you can apply online. You can check to see if your life event qualifies by going to Healthcare.gov and answering a few screening questions to see if you qualify for a special enrollment period.

If you have a special circumstance rather than a qualifying life event, you’ll want to contact the Marketplace call center directly at 1-800-318-2596. A representative will ask a few questions about your situation to help decide if you’re eligible for a special enrollment period.

Conclusion

While the annual open enrollment period is the ideal time to sign up for health insurance, life is messy and things can happen unexpectedly. That’s why special enrollment periods were created to help you make the necessary changes to your health insurance when the unexpected happens.

If you qualify for a special enrollment period because your employer has started offering an HRA, the experts at KindHealth can help you find a policy that works best for you and your family.

This article was originally published on August 1, 2019. It was last updated September 7, 2021.

Topics: Individual Health Insurance, Health Exchange, Health Insurance Marketplace, Open Enrollment

Additional Resources

See what you can expect to pay for health insurance in your state.
Learn when you can sign up for health insurance during the year.

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