Special Enrollment Periods (SEP) for Health Insurance

By Scott A. Yeager, M.A.

Unless you were hiding out deep in the Quehanna Wilds, you know that the deadline for the Health Insurance Marketplace and for securing your 2019 health insurance plan was Dec. 15, 2018.

OK, let’s say that you were afoot in the Quehanna Wilds until after New Year’s Day 2019 and missed your window to sign up for a health care insurance plan. What now?

Deadlines are deadlines for a reason. They are important. They help people and industries adjust to changing circumstances together. Not all deadlines are as bad as some of us are at meeting them on time.

If you missed the opportunity to sign up for a health care insurance plan this year, you might find yourself among those who do qualify under a Special Enrollment Period or SEP (they do love their acronyms) for enrollment beyond the Annual Enrollment Period.

“What do I need to do to qualify for a Special Enrollment Period,” you may ask? The information regarding SEP is laid out very well at healthcare.gov/coverage-outside-open-enrollment/changing-plans/.

We can think of a Special Enrollment Period as a defined period of time outside of the yearly Open Enrollment Period when people can sign up for health insurance. These time periods are further defined by qualified life events.

Life is always changing and people should be able to adapt to those events.

Again, “I forgot” is not considered a qualified life event. However, there are many circumstances that do qualify individuals to sign up for health care insurance beyond the Annual Enrollment Period, hence the Special in SEP:

  • In the past 60 days, did you get married?
  • In the past 60 days, did you have a baby, adopt a child or place a child for foster care?
  • In the past 60 days, did you get a divorce and lost your health insurance?
  • In the past 60 days, did someone on your plan die and as a result are you no longer eligible for health insurance?
  • Have you moved?
  • You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days.
  • Did you lose job-based coverage?
  • Did you lose individual health coverage for a plan or policy you bought yourself?
  • Did you lose eligibility for Medicaid or CHIP?
  • Did you lose eligibility for Medicare?
  • Did you lose coverage through a family member?

Special Enrollment Periods exist to help people in transition adapt their health care insurance to their new circumstances. And while missing the deadline for the Annual Enrollment Period is a significant barrier for some, there are special qualifying life events that can trigger the Special Enrollment Period.

If you believe that you may qualify for a Special Enrollment Period for enrolling in a health insurance plan outside of the yearly Annual Enrollment Period, please visit healthcare.gov and make your inquiry today.

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