Message from Wiley Long
President - ColoHealth
Share this page:

Everything You Need to Know About Special Enrollment Periods

Open enrollment ended January 31, 2017, and won’t begin again until November 1, 2017. Because there are specific guidelines regarding health insurance enrollment, it’s important to know all of your options inside and outside the open enrollment period.

Know Your Options Outside of Open Enrollment

Outside open enrollment, there are very limited options for getting health insurance.  However, if you’ve experienced a “qualifying life event,” you’re in luck – the ACA allows for a special enrollment period in this case.  Here are examples of qualifying life events:

Outside open enrollment, there are very limited options for getting health insurance.  However, if you’ve experienced a “qualifying life event,” you’re in luck – the ACA allows for a special enrollment period in this case. Here are examples of qualifying life events:

Getting Married

Getting married is considered a qualifying life event, which means you’ll qualify for a special enrollment period. After tying the knot, you’ll have a 60-day open enrollment window that begins on your wedding day when you can change your health plan. Even if you already have coverage, you may want to switch to a family plan that has every expense go towards a single family deductible.

Having a Baby

As soon as your baby is born, you can add the child to your policy or sign up for a completely new policy. You have 60 days to add the child's coverage, and the effective date will automatically be set to the date of birth. Maternity care and childbirth services provided before and after your baby is born are covered 100% under the new law since these are considered essential benefits.

This also applies when you add another dependent through adoption or gaining custody of a child. However, in this case, new regulations give parents the option to choose a later effective date.

Involuntary Loss of Coverage

If you lose your health insurance because you got laid off from your job or because of divorce, you qualify for a special enrollment period. You’ll have 60 days after your coverage ends to get a new plan.  Note that failing to pay the premiums or cancelling your health insurance plan does not make you eligible for a special enrollment period.

Permanently Moving to Another Demographic Location

If you permanently move to another area, you qualify for a special enrollment period. This is because each state offers different qualified health plans. However, you must have minimum essential coverage for at least one of the 60 days prior to your move in order to qualify for this special enrollment period. The only exception to this rule is for individuals living outside the United States or a United States territory prior to their move. In most cases minimum essential coverage means a plan that complies with the Affordable Care Act.

Newly-Gained American Citizenship

Note that this qualifying life event is only available on the health insurance marketplace. Carriers selling coverage off-exchange are not required to provide special enrollment periods for this instance.

Enrollment Errors or Misconduct by a Marketplace Broker/Assister

If the reason you weren’t able to get coverage in place on time is because of errors or delays caused by the insurance broker that assisted you, or the health insurance marketplace, you qualify for another opportunity to apply.

Income Changes

Becoming ineligible or newly eligible for advanced premium tax credits and cost sharing also qualifies you for a special enrollment period.

How Does A Special Enrollment Period Work?

If you experience a qualifying life event, you usually have 60 days from the actual life event date to seek other health coverage.  A qualifying event including marriage, loss of a job, or the birth of a child may also change your eligibility status for a premium subsidy.

If you’ve received advance notice that you’ll be losing your health coverage, some SEPs begin 30 days before your anticipated policy termination date and extend until 30 days after the policy termination date.  Our ColoHealth Personal Benefits Consultants will be glad to help you determine how long you have during your SEP to ensure that you have a policy before your SEP ends.

ColoHealth Personal Benefits Consultants can assist you in comparing your health plan options and determine if you qualify for a premium subsidy.  Plans offered through Connect for Health Colorado are guaranteed-issue, so you don’t have to worry if you have any pre-existing illnesses – you won’t be denied coverage!

Do you have questions about special enrollment periods?  Reach out to a ColoHealth Personal Benefits Consultant at 800-913-6381

How to Get a Health Plan if You Aren’t Eligible for a Special Enrollment Period

It’s possible you weren’t able to get enrolled by the open enrollment deadline, or maybe you weren’t able to continue paying your premiums – how do you get a health plan now? Few options are available outside the open enrollment period, but your best course of action at this point is a low-cost healthshare plan or go with a short-term health plan.  

Short-term plans are much less expensive than traditional health plans, and once you apply, you can usually have coverage within 24 hours.

 

Short Term Quote

Healthshare plans allow you to legally opt out Obamacare by choosing a completely different strategy for the coverage of your medical bills. Healthshare plans are backed by faith-based groups, and typically require that you agree to certain beliefs held by the members of the group in order to qualify for membership.

You must be in fairly good health to qualify, but you can sign up for membership at any time of the year, making these plans an excellent alternative outside of the Open Enrollment Period. Because they can often save you as much as 50% off your monthly cost for medical expense coverage, they’re actually a great option any time of the year!

 

You also have options for alternative coverage and additional benefits whether you missed open enrollment or want to protect yourself against accident or critical illness. Learn more on our Alternative Coverage Options page.