Open enrollment comes every fall, but you could lose coverage, add a new member to your family, or move at any time of year. What happens then? We get a lot of questions about this. The answer is applying during a special enrollment period. Read on for some answers about applying for health insurance outside of the open enrollment period.
Top Questions for the Special Enrollment Period (SEP)
What if I need to apply for health insurance outside of open enrollment?
You may be able to apply for health insurance during a special enrollment period (SEP). This is a period of time outside of the open enrollment period in which you may be eligible to apply for an individual or family health plan. If you experience a qualifying life event, such as getting married, having or adopting a baby, losing your coverage, or moving into a new service area, you may qualify for SEP. See if you qualify to enroll outside of Open Enrollment Period.
What is a qualifying life event?
A qualifying life event is a change in circumstance that may allow you to enroll in coverage outside of the annual open enrollment period. Qualifying life events include:
- Having a baby
- Getting married
- Adopting or fostering a child
- Loss of coverage because of the following events:
- Losing coverage through your job
- Getting separated or divorced from your spouse
- Death of policy holder
- COBRA expiration
- Losing eligibility for Medicaid or CHIP
- Moving to a new area
- You change your permanent residence to the Independence Blue Cross five-county service area: Bucks, Chester, Delaware, Montgomery, or Philadelphia counties.
- Becoming a U.S. citizen
When can I enroll for health coverage if I experience a qualifying life event?
The special enrollment period is determined by the type of qualifying life event. In most cases, you will have 60 days after the life event to enroll in or make changes to a health plan.
Certain life events, like moving into the Independence Blue Cross coverage area (Bucks, Chester, Delaware, Montgomery, or Philadelphia counties), allow you to apply for a health plan up to 60 days before the event. If you are losing coverage provided by an employer, you will have up to 60 days before and after the event to enroll in a health plan.
Is getting engaged or moving in with my partner a qualifying life event?
No. Only getting married will qualify you and your partner for a special enrollment period.
I know that having a baby is a qualifying life event, but what about adopting or fostering a child?
Absolutely! Adopting or fostering a child is a qualifying life event and qualifies you for a special enrollment period.
Does it matter if I quit my job or if I am let go?
No. If you were previously covered through your job and you lose that coverage, you may apply for a special enrollment period to purchase health insurance.
If I get COBRA after I lose coverage through a job, can I still apply for a special enrollment period?
Yes, you can apply for special enrollment period if you cancel your COBRA benefits or if they are set to expire.
Can I still enroll for health insurance during an SEP if I cancel my health insurance plan, or if my plan is canceled?
Sorry. Loss of coverage due to voluntarily canceling your health insurance plan, having your plan canceled because you did not pay your premium, or losing your coverage because your plan did not meet the requirements as stated by the Health Care Law do not qualify you to enroll during a special enrollment period.
What if I miss open enrollment and don’t have a qualifying life event?
You will have to wait for the next open enrollment period to apply for a health insurance plan.
Have a question we don’t answer here? Learn more about special enrollment and qualifying life events.
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