Annually, Americans have a set time window to alter or enroll in individual and family private medical insurance for the following 12 months. This is named the Open Enrollment Period (OEP), which often runs from November to mid-January.
But what if you have to enroll for medical insurance outside of that timeframe? You have got options! Let’s take a have a look at how a qualifying life event could make you eligible for the Special Enrollment Period and what sort of life changes qualify.
What’s the Special Enrollment Period (SEP)?
The Special Enrollment Period (SEP) is a time window for people to enroll in medical insurance outside of the open enrollment period. It is frequently triggered by a qualifying life event (QLE). SEP ensures that individuals going through certain life changes, especially those who lead to lack of health coverage, can enroll in a latest health plan.
What’s a qualifying life event?
A qualifying life event, sometimes known as a qualifying change of status, is a change in your current circumstances that makes you eligible for SEP. But what does that mean? Consider it by way of a serious life event. If you happen to experience something that affects your household size or involves a change in where you reside, income or access to medical insurance, chances are you’ll qualify.
What number of days after a qualifying life event do you have to enroll in a medical insurance plan?
In most situations, you’ve got 60 days from the date of the qualifying life event to use for medical insurance. Nevertheless it looks different depending on the state. Depending in your situation, some states allow a 60-day window each before and after a qualifying life event to enroll in coverage.
Status changes: Marriage, divorce and legal separation
Marriage, divorce or legal separation are considered eligible life events. Every situation changes the scale of your household and your coverage must be adjusted to reflect that change.
Marriage: Married couples could have 60 days from the date of their wedding to alter coverage, including adding their spouse to an employer-sponsored health plan.
Divorce or legal separation: Within the event of a divorce, a spouse who doesn’t have a policy can buy their individual plan under SEP in the event that they have a divorce decree or proof of legal separation. Nevertheless, this will get complicated depending on court proceedings and state regulations.
Is getting pregnant a qualifying life event?
While this varies by state, typically becoming pregnant will not be considered a qualifying life event. But don’t fret – in case your prenatal care is provided online, your current insurance should cover it. It is important to call your insurer and ask questions before your first prenatal visit to see what your insurance will and won’t cover.
What about childbirth or adoption?
Each birth and adoption are considered qualifying life events as you add a latest dependent to your medical insurance and alter your household size. Normally, parents have 60 days from the birth or adoption of a toddler to enroll for insurance for their infant.
Is losing or getting a latest job a qualifying life event?
Yes, when you lose your employer-sponsored healthcare, you qualify for a special enrollment period. There is no such thing as a distinction between voluntary departure from the workplace, as within the case of resignation, and involuntary departure, as within the case of dismissal or dismissal.
Involuntary or voluntary lack of medical insurance
Normally, an involuntary lack of medical insurance, reminiscent of divorce or the death of a family policyholder, qualifies you for SEP. But what about voluntary? And what is taken into account “voluntary loss”?
You won’t qualify for a special enrollment period when you voluntarily opt-out. This includes lack of coverage as a consequence of non-payment of premiums or cancellation of a parent or guardian’s plan.
Is quitting your job an involuntary lack of medical insurance?
Yes, leaving your job, regardless of the situation, counts as an involuntary lack of medical insurance. This may increasingly come as a surprise when you quit your job voluntarily, but consider it this fashion – while chances are you’ll decide to quit your job, technically you are not selecting to lose your medical insurance.
End of Medicaid coverage
Chances are you’ll be eligible for SEP if you’ve got been denied or lost Medicaid coverage as a consequence of changes in income, a toddler in your household has aged from the Kid’s Health Insurance Program (CHIP), or other qualifying circumstances occur. You possibly can contact the Medicaid office in your state to learn more.
Is the departure of a spouse from work a qualifying event?
Yes. In case your spouse quits their job, this is taken into account an involuntary lack of medical insurance, regardless of the situation. If he was the one whose employment provided medical insurance, you may apply for a latest plan in the course of the Special Enrollment Period. In case your spouse leaves work and you must include them in your medical insurance, this may trigger SEP as well.
Is popping 26 a qualifying life event?
Turning 26 is a qualifying life event. That is when most dependents lose access to their parents’ medical insurance. Depending on where you reside, you could have 60 days before your cover expires and 60 days after that to seek out a latest plan in the course of the special enrollment period.
If there was a death within the family
If you happen to share medical insurance with a deceased member of the family, it is a qualifying life event. Examples include the lack of a primary family medical insurance policyholder, the lack of a minor child, and the lack of a member of the family whose income contributed to coverage.
If you happen to exit of range
If you happen to move outside your medical insurance coverage, chances are you’ll be eligible to enroll in a latest plan during SEP. In accordance with HealthCare.gov, this will include moving to a latest zip code, leaving a transitional housing situation reminiscent of a shelter, or a student moving to highschool.
Do you’ve got more questions on individual medical insurance?
Our experts can assist you discover a health plan you’ll be able to trust, regardless of the situation.