What You Need to Know about Health Insurance Enrollment Periods

If you’re looking for health insurance and you’re under 65 years of age, then you might already know that the standard open enrollment period for changes or new enrollments is November 1 through December 15.

However, one of the provisions of the Affordable Care Act was specifying that certain individuals could enroll in health insurance plans at any point throughout the year. There simply has to be a specific qualifying event. These qualifying events, in general, relate to a loss of health insurance coverage or a change in life situations that would affect one’s coverage.

Let’s review these situations.

A List of Special Enrollment Periods for Health Insurance

Each of these events results in what is termed a Special Enrollment Period or SEP for that person. Once one of these events occurs, the individual seeking health insurance has 60 days in which to enroll in a new health insurance plan.

  • An individual loses health insurance because of divorce or legal separation.
  • A couple gets married.
  • A couple or individual has a baby, adopts a child, or accepts a child for foster placement.
  • A child support order becomes effective.
  • A death of the insured person deprives a person of their health insurance.
  • The household moves to a different state.
  • The household moves to the US from a foreign country or territory.

It’s important to note that if a person enrolls, the coverage will not be retroactive. For example, suppose a person loses coverage then waits 45 days to enroll in a new plan. Any medical expenses in that 45 day period, in which the person did not have insurance, will not be covered.

Once that individual gets enrolled in a new plan, their coverage will become effective on the first day of the next month. At that point, they can begin to receive care under their new plan.

Special Announcements of New SEPs

From time to time, the federal government announces temporary SEPs that can be utilized by those with or without insurance coverage. For example, in March 2021, the Department of Health and Human Services announced a three-month period in which individuals could get a new plan or change plans to one that would save them money. This announcement came after the implementation of the American Rescue Plan that was designed to decrease the cost of premiums.

These special announcements occur from time to time so if you want to change your coverage or you have missed an open enrollment deadline, you could have another chance to enroll.

The Challenge of Special Enrollment Periods

It’s estimated that somewhere between eight and ten million Americans are eligible for one of these SEPs every year but not many take advantage of the opportunity. It could be because they don’t know about SEPs, or because it would be hard to verify their eligibility. And actually, there are many laws affecting enrollment during these special enrollment periods. It’s not the simplest matter to navigate.

Those who might need one of these Special Enrollment Periods the most could be people in lower income jobs, those newly entering the workplace, or workers with poor language skills. That’s when it’s helpful to have someone in your corner, looking out for your interests.

MBhealth knows just how to make obtaining coverage in open enrollment periods or SEPs fast and as simple as possible. This is what we do every day. If you think you might qualify for a SEP, your best bet is to get the help of an experienced consultant like MBhealth. Even if you’re not sure, give us a call at (314) 544-5400, and we’ll answer your questions.

When we help people get health insurance coverage we are working for you and only you, not the insurance companies.

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