What to Know About ACA Special Enrollment Periods
You can get an earlier coverage start when you qualify, thanks to certain life events.
Have you moved? Changed jobs? Turned 26? Had a baby? Congratulations!
You’ve just experienced something that’s called a Qualifying Event (QE). These events (and others—more on that in a moment) mean you may get new health insurance through the Affordable Care Act’s (ACA) Marketplace right now. You don’t have to wait for the next Open Enrollment Period that begins November 1.
While you might not think a life event can trigger health care options through a Special Enrollment Period (SEP), they do. And they give you access to ACA-compliant health plans—subsidized to your income and WITHOUT preexisting condition exclusions.
What Triggers a SEP?
Here’s a quick list of 10 events that open the door immediately, and a #11 catch-all that might mean you still can qualify.
- You -or anyone in your household- lost qualifying health coverage. A job change usually triggers this one, but it can also be you turned 26 and aged out of your parent’s health plan.
- You married.
- You divorced.
- You moved to a new county or zip code.
- Your employer’s plan increased in cost and you find it unaffordable.
- Your employer pays you to find your own insurance. This is called gaining access to a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or Health Reimbursement Account (HRA).
- Your income changed. For example, you may qualify for a subsidy or premium tax credit where before you did not.
- You had a baby (or gained a dependent).
- You became a U.S. citizen.
- Your current health plan renews before November 1. These are mostly older plans that renew on a schedule different than the calendar year.
- Various exceptional circumstances. These might apply to everyone in an area, like a hurricane or other disaster, or on a case-by-case basis, such as you experience spousal abandonment or abuse, are released from prison, or in some states, become pregnant or are in Medicaid or the Children’s Health Insurance Program (CHIP). Or, there was an error in a previous attempt to enroll. NOTE: If your state runs its own marketplace (18 do), it may have SEPs in addition to those listed here. Plus, you have the right to appeal if your SEP enrollment was denied.
What If I Think I Qualify?
It makes good sense to consider Marketplace health coverage if you qualify for it. More savings and lower costs could be available. And because it’s not job-based, you never have to worry about losing your insurance if you get too sick or hurt to work.
So What’s Next?
If you think you qualify, just pick a plan—it really is that simple.
Here’s where Indigo makes it even easier—you can preview plans and prices available in your area and get expert help if you need it. It’s an extremely easy way to navigate what’s available on both Federal and State exchanges. Best of all, it’s free to use.