SPECIAL ENROLLMENT PERIODS AVAILABLE FOR ACA HEALTH INSURANCE

First published in Landings, February, 2017

Welcome to February! If you missed the open enrollment period for ACA health insurance, which closed on January 31, you will have to wait until November of this year to enroll in a plan for 2018. Th ere are a few exceptions, typically the result of a a significant life event.

After the open enrollment period ends, consumers still have the opportunity to enroll in qualified health plans if they experience certain life changes, such as marriage or a permanent move to an area with new coverage options. These opportunities outside of open enrollment are called special enrollment periods, or SEPs.

A qualifying event can occur at any point during the year. Th e ability to enroll in a health insurance plan through a SEP lasts 60 days from the date of the qualifying event. A SEP can be something that occurs in one of the following six categories:

1. Loss of qualifying health coverage: if you (or anyone in your household for whom they seek coverage) lose qualifying health coverage. Some examples of qualifying health coverage include:

•Coverage through a job, or through another person’s job

• Medicaid or Children’s Health Insurance Program (CHIP) coverage (including pregnancy-related coverage and medically needy coverage)

• Medicare

• Individual or group health plan coverage that ends during the year

• Dependent coverage that a consumer has through a parent’s plan. If you turn 26 or the maximum dependent age allowed in your state and lose coverage, you can qualify for an SEP.

2. Change in household size: a consumer may qualify for an SEP if you (or anyone in your household):

• Got married

• Had a baby, adopted a child, or placed a child for foster care

• Got divorced, legally separated, or had a death in the family and lost health coverage

• Gained or became a dependent due to a child support or other court order

3. Change in primary place of living: if you (or anyone in your household) has a change in your primary place of living, such as:

• Moving to a new home in a new zip code or county where new qualified health plans are available

• Moving to the U.S. from a for eign country or United States territory

• A student moving to or from the place he or she attends school

• A seasonal worker moving to or from the place he or she lives and works

4. Change in eligibility for Marketplace coverage or help paying for coverage. If you (or anyone in your household) is enrolled in Marketplace coverage and reports a change that makes the consumer:

• Newly eligible for help paying for coverage

• Ineligible for help paying for coverage

• Eligible for a different amount of help paying out-of-pocket costs

Many changes in circumstance or life events can trigger SEPs, but you should understand that not all changes will allow you to enroll in or change plans. Some changes that do not trigger an SEP include:

• Loss of minimum essential coverage due to failure of payments

• Voluntary COBRA cancelation

• Pregnancy (a birth, however, will lead to an SEP)

• Income changes, unless a consumer is currently enrolled in a qualified health plan or their income rose above the 100% Federal Poverty Line

• Loss of coverage for more than 60 days.


If you think you qualify for a SEP and want help with your health insurance options, please call me at 207-967-4555 or send an email to alisha@mainelobstermen.org