“What Happens If…?” Special Health Insurance Enrollments Available For Life Changes

Bridget Thornton is MLA’s health insurance Navigator. MLA photo

The new year is upon us and health insurance open enrollment is behind us. That means that if you did not enroll in a plan for 2018, you can now only do so if you qualify for a special enrollment period. You may be eligible to sign up for health insurance through a special enrollment period if you have a “qualifying life event.” This refers to a change in your situation, like getting married, having a baby, or losing health coverage through your job. If you have a qualifying life event, you can enroll in a Marketplace plan outside the yearly Open Enrollment Period.

What is a qualifying life event? Let’s look at a few real-life examples.

Sarah is having a baby: does she qualify for a special enrollment period?

Yes! If Sarah is already enrolled in a Marketplace plan, she should “report a life change” on her 2018 application and add her new baby to the plan. If Sarah does NOT have a Marketplace health insurance plan, she is eligible to enroll the day the baby is born; there is a 60-day window after birth to enroll in a plan. She can also change to a different plan if she would like to.

Katie recently lost her job and is no longer eligible for her employer’s health plan. Her plan also covered her husband and their two children. Are they eligible for a special enrollment period?

Yes! Because Katie lost her job through which she had health insurance for herself and her family, they can all apply for a plan in the Marketplace. Katie has 60 days before her health insurance ends and 60 days after she loses her coverage to enroll in a plan. Coverage would start the first day of the month following enrollment.

Cameron is turning 26 in May and has health coverage through his parent’s job. Under the Affordable Care Act, once he turns 26, he will no longer be able to stay on his parent’s plan. Does he qualify for a special enrollment period?

Yes! Cameron can apply for health coverage through the Marketplace. His special enrollment period starts 60 days before he loses coverage (the company should send the parent a letter telling him or her when his coverage would end) and ends 60 days after. If Cameron enrolls before he loses coverage, the new Marketplace plan would start the first day of the month after his coverage ends. If he enrolls after losing coverage, the new plan would start the first day of the month after he picks a plan. If Cameron’s parents had a plan through the Marketplace and he was insured through their family plan, he would be eligible to stay on this plan through December 31, 2018, even if he turned 26 mid-year.

Here are a few more examples of qualifying life events:

Changes in residence, like moving to a new zip code or state. (You need to prove that you had health insurance for one or more days during the 60 days before your move.)
Changes that make a person no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP). These are state-run programs and you qualify based on income.
Gaining membership in a federally-recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
Becoming a U.S. citizen.
Leaving incarceration.
AmeriCorps VISTA members starting or ending their service.
There are also other qualifying life events that can make you eligible for a special enrollment period. You can find these at healthcare.gov or you can call the MLA office at 967-4555 and ask to speak with a health insurance Navigator.