What triggers a special enrollment period for individual health in 2019?

According to HealthCare.gov, the following qualifying life events can result in special enrollment eligibility3:

  • Loss of health coverage – This includes losing your current job-based, individual and student plans; eligibility for Medicare, Medicaid or CHIP; and turning 26 and aging out of a parent’s plan.
  • Changes in the household – This includes getting married or divorced, having a baby or adopting a child, or experiencing a death in the family.
  • Changes in residence – This includes moving to a new ZIP code or county, students moving to or from the place they attend school, seasonal workers moving to or from the place they both live and work, and moving to or from a shelter or other transitional housing.
  • Other qualifying events – This includes income changes that affect the coverage for which you qualify, 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 jail or prison, or AmeriCorps members starting or ending their service.

These are the most common ways to qualify for a special enrollment period; however, there may be other situations in which you could become eligible. To determine whether or not you qualify

Under new regulations effective in 2017, you will be required to provide documentation that confirms your eligibility.

How long does special enrollment last?

Your eligibility begins with the date of your qualifying life event. The length of your special enrollment period depends on what situation triggered it, but 60 days is common.4

To find out if you qualify for a special enrollment period and for what duration:

  • Visit HealthCare.gov and answer a few questions. This screening tool will help you determine whether or not you may be eligible and point you toward the correct state-based or federally facilitated exchange from which to begin the application process

What if I don’t want to buy from an exchange?

Special enrollment is not confined to state-based and federally facilitated health insurance exchanges. If you qualify for special enrollment, you may also purchase qualified health insurance plans in the private marketplace.

Note, however, that premium tax credits and cost-sharing subsidies may only be applied to health insurance plans purchased through state-based and federally facilitated exchanges.

Not eligible for special enrollment?

You may consider health insurance options that are available for year-round. short-term, coverage.  Applicants for these plan types are subject to certain eligibility criteria. Check out our alternative web page.

For additional information, click here.

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