How do you qualify for a special enrollment period for health insurance? – Forbes Advisor

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You can usually make changes to your health insurance coverage during annual open enrollment, but you may also be able to change your health insurance if you qualify for a special enrollment period.

You may be eligible for special enrollment if you have a “qualifying life event,” such as losing health insurance coverage, getting married, having a baby, or moving.

What is Open Enrollment for Health Insurance?

Open enrollment is the time of year when you can change your health insurance coverage. Healthcare.gov’s Affordable Care Act Marketplace has open enrollment between November 1 and January 15 in most states. A few states such as California and New York operate their own marketplace and may have longer open enrollment periods.

People who get health insurance through their employers will likely have a different open enrollment period than the ACA marketplace. Employers choose their own open enrollment period each year.

How does special recording work?

A special enrollment period is when you can sign up and change health insurance outside of the open enrollment period if you have a qualifying life event.

There are several reasons why you may qualify for a special enrollment period. If you or someone in your household experiences any of the following, you may be eligible for special enrollment within 60 days of the change:

  • Birth or adoption of a child
  • Getting married
  • Divorce or separation
  • Moving to a new zip code, to another state, or out of state, including if you are a student or seasonal worker
  • Losing your health insurance, such as being laid off and losing an employer-sponsored health plan, or your spouse losing coverage
  • A change in income that makes you eligible for premium tax credits and subsidies in the ACA marketplace
  • Loss of Medicaid eligibility based on your income
  • Dropping out of your parent’s health plan at age 26
  • Death of spouse or dependent

Special enrollment periods for health insurance generally last 60 days from the qualifying event, although some exceptions apply. Your state may set different dates or give you a longer or shorter period of time to adjust your coverage.

How do I prove I’m eligible for a special enrollment period?

For plans on the ACA Marketplace

You must show that you are eligible for special enrollment in the ACA marketplace.

Think about what kind of coverage you need and choose a plan if possible. You have 30 days to complete and submit an application to the ACA Marketplace. If additional information is required, you will be notified with specific details about the documents you need to provide.

Here are some documents you may need to show in order to enroll, including during special enrollment:

  • Marriage license
  • Adoption documents
  • Utility bills or similar document showing you’ve moved
  • Notice from an insurance company that you have lost health insurance coverage
  • Premium bill from previous insurance company showing cancellation or termination of coverage
  • A letter from an employer confirming a change in coverage for a member of your household
  • COBRA Coverage Letter
  • Document showing loss of coverage due to divorce, legal separation, custody arrangements, or annulment

If you don’t have either of these documents, you can use the letter of explanation to confirm life events by completing the Loss of Coverage section to explain your specific situation.

If you qualify for a special enrollment period, you can go to the ACA Marketplace and search for a plan just like during open enrollment.

The Marketplace lets you compare plans in your area side-by-side. After you enter your income and household size, the website estimates the cost of plans in your area and takes into account premium tax credits and subsidies. Only ACA plans are eligible for these cost savings programs.

For health plans through work

If you want to add or change health insurance through an employer, check with your employer about health plan options. Like the ACA marketplace, you’ll need to provide proof of your qualifying life event. Once you provide this information, you should be able to choose between the plans offered to employees.

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