When you’re enrolling in a health plan for the upcoming year, it can be easy to get overwhelmed.
The number of insurance companies and plans available make it difficult to say what you want or who you want to get coverage from—much less know if your new plan is the right one.
There are many factors that go into deciding whether or not a health plan is the right fit, but luckily there are also many special enrollment periods that make it easier to switch plans if you find that you’re not getting what you need.
If you have qualifying life events, you can enroll in a new health plan at any time of year. This means that even if the open enrollment period has ended, you can still get the coverage you need.
Qualifying life events can be broken down into two categories: triggering events and non-triggering events.
When it comes to special enrollment qualifications, both types of life events are acceptable reasons to change your health plan on short notice (provided the reason is not an exclusion).
However, most special enrollment periods are triggered by either a triggering event or both—meaning that you’ll likely need to provide some form of documentation.
What is a qualifying life event?
A triggering event (or 60-day rule) is any change in your life that leaves you uninsured for at least 63 days. This constitutes an unintentional lapse in coverage and makes you eligible for a special enrollment period.
The most common triggering event is losing health insurance as a result of losing eligibility, voluntarily ending your policy, or disqualification from your plan due to non-payment.
Who qualifies for the special enrollment period?
Any individual that lost qualified health coverage can qualify for a special enrollment period—no matter their current health status. This is true even if an individual was covered but had a preexisting condition and lost coverage due to the plan not covering their condition.
Does it make a difference how I lost my qualified health coverage?
Any loss of coverage qualifies you for a special enrollment period, including losing on-campus (student health plans) or off-campus coverage. Coverage can also be lost if the employer contribution stops, the policy is canceled, or the insured person is no longer employed by the company.
What are some non-triggering life events?
Non-triggering life events (or 90-day rule) are changes in your life that don’t leave you uninsured for at least 63 days. These events are not usually eligible for a special enrollment period, but they can be in some cases. The most common non-triggering life event is a change in your family size (birth, adoption, or marriage). Other examples include gaining or losing Medicaid or CHIP eligibility, becoming a U.S. citizen, or moving to a new insurance company’s service area.
What qualifies me for a special enrollment period?
If you have qualifying life events that either apply to triggering events or non-triggering events, you can receive a special enrollment period. In most cases, the reason for the special enrollment period must be provided when getting coverage outside of the open enrollment period.
What are the benefits of a special enrollment period?
A special enrollment period can be beneficial because it allows you to enroll in a new health plan without penalty. It also gives you the opportunity to select a new health plan that better meets your needs. In some cases, you may also be able to renew your current health plan without proof of prior coverage.
What are the disadvantages to a special enrollment period?
Special enrollment periods only apply for people who did not intentionally allow their previous plan to lapse. This means that if you let your policy expire, you will be stuck with significant premium increases and exclusionary periods (up to 12 months or more). You can avoid these penalties by shopping for a new health plan during the next open enrollment period.
Can I continue my existing coverage?
Yes, as long as you do not allow your current policy to lapse and you keep paying the premiums on time. If you ignore your premium obligations or your insurer determines that your policy is no longer in force, they may terminate your coverage.
What is the process for enrolling in a new health plan outside of open enrollment?
The process will vary depending on your state, but it typically involves applying for coverage through your state’s health insurance marketplace or directly with an insurance company. You may also be able to use a broker to help you find and enroll in a new health plan.
If I qualify for a special enrollment period, how long do I have to enroll?
The length of your special enrollment period will depend on the event that triggers it. Generally, you will have 60 days from the date of the event to enroll in a new health plan. However, some events (like losing Medicaid or CHIP eligibility) have a shorter enrollment period.
In most cases, you will only be able to enroll in a new health plan outside of open enrollment if you have a qualifying life event. If you don’t have a qualifying life event, you will have to wait until the next open enrollment period to sign up for coverage.
