The annual Open Enrollment Period (OPE) for comprehensive individual health insurance runs from November 1 – January 15 each year. This is the one time every year you can enroll in, re-enroll in, or change your health insurance plan through the Health Insurance Marketplace.
After the annual Open Enrollment Period, the only other time you can enroll in or change your health insurance plan through the Marketplace is if you qualify for a Special Enrollment Period.
Special Enrollment Period
A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You may be eligible for a Special Enrollment Period if certain life events, deemed ‘Qualifying Life Events,’ happen to you or a member of your household.
Woligo’s licensed team of product-trained enrollers can help determine if you qualify for a Special Enrollment Period and assist you with the enrollment process.
Types of Qualifying Life Events (QLE)
There are four main types of life events that can activate a Special Enrollment Period such as:
- Loss of qualifying health coverage
- Change in household size
- Change in primary place of living
- Change in eligibility for Marketplace coverage or help paying for coverage
Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan.
Qualifying Life Event: Loss of qualifying health coverage
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage (or “minimum essential coverage”) in the past 60 days OR expects to lose coverage in the next 60 days.
Some examples of the loss of qualifying health coverage are:
- You lose health coverage through your employer or the employer of a family member
- Your individual plan or your Marketplace plan is discontinued (no longer exists)
- You lose eligibility for a student health plan
- You lose eligibility for a plan because you no longer live in the plan’s service area
- Your individual or group health plan coverage year is ending in the middle of the calendar year, and you choose not to renew it
- Your household income decreased, and now you qualify for savings on a Marketplace plan
- Your eligibility for federal programs like Medicare Part A, Medicaid or Children’s Health Insurance Program (CHIP) coverage changes
- You lose coverage under your parent’s health plan. If you turn 26 and lose coverage, you can qualify for this Special Enrollment Period
Qualifying Life Event: Change in household size
You may qualify for a Special Enrollment Period if in the past 60 days you or anyone in your household:
- Got married
- Had a baby, adopted a child, or placed a child for foster care
- Gained or became a dependent due to a child support or other court order
- Got divorced or legally separated and lost health insurance
- Passed away
Qualifying Life Event: Change in primary place of living
You may qualify for a Special Enrollment Period if you (or anyone in your household) had a change in your primary place of living and gain access to new Marketplace health plans. Household moves that qualify you for a Special Enrollment Period include:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or U.S. territory
- Moving to or from the place you attend school
- Moving to or from the place of your seasonal employment
- Moving to or from a shelter or other transitional housing
Note: You only qualify for a Special Enrollment Period if you had qualifying health coverage for at least 1 day in the 60 days before your move. You don’t qualify if:
- You were living in a foreign country or a U.S. territory for at least 1 day in the 60 days before the move.
- You lived for at least 1 day in the 60 days before your move or during your most recent enrollment period in a service area where you couldn’t get qualifying health coverage through the Marketplace.
Qualifying Life Event: Change in eligibility for Marketplace coverage
You may qualify for a Special Enrollment Period if you (or anyone in your household):
- Are enrolled in Marketplace coverage and report a change that makes you:
- Newly eligible for help paying for coverage
- Newly ineligible for help paying for coverage
- Eligible for a different amount of help paying for out-of-pocket costs, like copayments
- Become newly eligible for Marketplace coverage because you’ve become a citizen, national, or lawfully present individual
- Become newly eligible for Marketplace coverage after being released from incarceration (detention, jail, or prison)
- Become newly eligible for help paying for Marketplace coverage because you moved to a different state and/or had a change in household income and you were previously both of these:
- Ineligible for Medicaid coverage because you lived in a state that hadn’t expanded Medicaid
- Ineligible for help paying for coverage because your household income was below 100% of the Federal Poverty Level
Qualifying Life Event: Enrollment or plan error
You may qualify for a Special Enrollment Period if you (or anyone in your household) has problems with enrollment or experiences a plan error. For example, if you:
- Weren’t enrolled in a plan or were enrolled in the wrong plan because of:
- Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, Navigator, certified application counselor, agent or broker)
- A technical error or other Marketplace-related enrollment delay
- Incorrect plan data (like benefit or cost-sharing information) that displayed on HealthCare.gov at the time that you chose your health plan
Qualifying Life Event: Other extenuating circumstances
There may be additional reasons that prevented you from getting coverage during the Open Enrollment Period. The Marketplace has already addressed some additional life changes that may qualify for a Special Enrollment Period. If you (or a member of your household):
- Are eligible for premium tax credits and have an estimated household income at or below 150% of the Federal Poverty Level
- Applied through the Marketplace for Medicaid or Children’s Health Insurance Program (CHIP) coverage during Open Enrollment or because of a qualifying event
- Your state Medicaid or CHIP agency determined you (or anyone in your household) weren’t eligible after Open Enrollment ended, or more than 60 days had passed since your qualifying event
- Are a victim of domestic abuse or spousal abandonment and want to enroll yourself and any dependents in a health plan separate from your abuser or abandoner
- Submitted documents the Marketplace requested to confirm your eligibility, but your coverage had already ended after a failure to confirm your eligibility
- Are not a US citizen but have a household income under 100% of the Federal Poverty Level, submitted documents to prove that you have an eligible immigration status, and didn’t enroll in coverage while you waited for your documents to be reviewed
- Are an AmeriCorps service member starting or ending AmeriCorps service
- Can show you had an exceptional circumstance that kept you from enrolling in coverage, like being incapacitated, a victim of a natural disaster, or impacted by another type of national or local emergency or disaster during an Open Enrollment Period or another Special Enrollment Period qualifying event
- Have newly gained access to an individual coverage Health Reimbursement Account (HRA), or are newly provided a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
Will I have to provide proof of my qualifying life event?
Yes! Before you can start using your coverage, you must either upload your evidentiary documents online or mail copies (don’t send originals). After you pick a plan, you have 30 days to send acceptable documents. Your coverage will start based on when you pick a plan. But you can’t use your coverage until your documents confirm you qualify for a Special Enrollment Period, and you make your first premium payment.
(But don’t worry, Woligo can help you submit all of the necessary documents!)
What if I think I qualify for a Special Enrollment Period?
If you think you qualify for a Special Enrollment Period, Woligo’s licensed team of product-trained enrollers will help you complete the enrollment process. We will review product options, plan features and network and provider limits to ensure the plan selected meets your needs.