When the calendar turns to November 1 for the Affordable Care Act (ACA), the next six weeks of the official enrollment period fly by faster than a James Harden shake and bake move to the basket. If you missed the Open Enrollment Period (OEP) for a Health Insurance Marketplace plan, does that mean you have to wait until next November 1 to enroll?
The answer is no for two reasons. You can enroll for health insurance during a Special Enrollment Period (SEP), but you have to meet the criteria that qualify you for enrollment in a SEP. The second reason is unique because it addresses the health crisis associated with the Coronavirus pandemic. In 2021, you have until August 15 to enroll in or modify your Health Insurance Marketplace plan.
What Qualifies You for a SEP?
Because the Federal Emergency Management Agency (FEMA) declared the COVID-19 pandemic to be a national emergency, you might still be eligible for a SEP even if you missed the original deadline for enrolling in an ACA-backed health insurance plan.
Let’s look at a few additional ways that can qualify you for a SEP.
One or More Household Changes
You might be eligible for a Special Enrollment Period if you or any member of your household had the following events unfold over the previous 60 days:
- Marriage
- Gave birth or adopted a child
- Finalized a divorce or legally separated
- Death
Resident Change
Changing residences might qualify you for a SEP. Moving to a new home in a different zip code or county is the most common reason why you can participate in a SEP. Another common reason for approval of a Special Enrollment Period is if you relocate to another country. Students that attend school in a different zip code and seasonal workers that move away from where they live also might qualify for a SEP.
Losing Health Insurance Coverage
If you or any member of your household lost qualifying health insurance coverage over the past 60 days, you might qualify for a Special Enrollment Period. The same qualification criteria apply if you or anyone in your household expects to lose health insurance coverage over the next 60 days.
Here are several ways that you can qualify for a SEP because you lost health insurance coverage:
- Lost job-based coverage
- Lost coverage for an individual policy that you purchased
- No longer qualify for Medicaid
- Lost eligibility for Medicare coverage
- Lost coverage from a family member’s policy
Other Health Care Coverage Changes
Gaining membership into a federally designated Native American tribe might qualify you for a SEP, as well as receiving your release from incarceration in a state or federal prison. If you recently became a United States Citizen, the ACA grants you the right to purchase a Health Insurance Marketplace plan. Anyone beginning or ending service for AmeriCorps State and National also might qualify to participate in a Special Enrollment Period.
The law regarding eligibility for a SEP changes occasionally, which means the criteria used for participating in a SEP during 2021 might differ from the criteria required for participation in a SEP during 2022.
National Disaster
If you qualified for Health Insurance Marketplace coverage during Open Enrollment or a Special Enrollment Period, but a natural disaster caused you to miss the deadline, you might qualify for a different Special Enrollment Period. The key is for FEMA to declare a natural disaster, which typically happens when there is a significant amount of property damage and/or loss of life. You must live in a county that meets the eligibility requirements for either public assistance or individual assistance. FEMA requires you to participate in a natural disaster SEP within 60 days after the end of the FEMA-declared incident period.
The Importance of Paperwork
When you apply for Health Insurance Marketplace coverage during a Special Enrollment Period, you will have to submit the information that verifies your eligibility to participate in the SEP. You should organize the documents associated with the life event that caused you to miss the Open Enrollment Period. For example, if you or your spouse gave birth during the Open Enrollment Period, you need to submit the birth certificate of the newborn, as well as any supporting medical records.
Learn more about the ACA by visiting the Health and Human Services (HHS) website.
Navigate Special Enrollment Periods With Insurance Broker Hub
Finding health insurance is still one of those things that is a mystery for many Americans, and navigating the maze that is healthcare.gov is rarely as easy as promised. If you’re looking for help understanding your options, Insurance Broker Hub can help.
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