Orlando Harmon
If you're expecting to lose your health insurance in the near future, you may be eligible for a Special Enrollment Period (SEP) to sign up for a new health insurance plan outside of the yearly Open Enrollment Period. This is a qualifying life event that allows you to enroll in a new health insurance plan through the exchange/Marketplace in your state or directly through an insurer. To qualify for an SEP due to future loss of insurance, you must meet certain criteria and submit the required documents within specified time frames.
| Characteristics | Values |
|---|---|
| Qualifying for a Special Enrollment Period (SEP) | Losing health coverage, moving, getting married, having a baby, adopting a child, decrease in household income, or if your household income is below a certain amount. |
| Time to qualify for SEP | If you lost health coverage in the past 60 days or expect to lose coverage in the next 60 days. If you lost Medicaid or CHIP coverage, you have 90 days. |
| Documents required | Scanned copies or clear photos of documents confirming loss of coverage, such as a letter from your employer or insurance company. |
| Time to submit documents | Within 30 days of picking a new plan. |
| Start of new coverage | The first day of the month after your previous coverage ends and you pick a new plan. |
| Involuntary loss of coverage | If your insurer exits the market or terminates your plan and offers new replacement plans. |
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What You'll Learn
Qualifying for a Special Enrollment Period (SEP)
You may qualify for a Special Enrollment Period (SEP) if you have experienced certain life events, including:
- Losing health coverage
- Moving
- Getting married
- Having a baby
- Adopting a child
- Gaining U.S. citizenship, legal presence, or refugee status
- Being released from incarceration
- Losing employer-provided health coverage
- Turning 26 and aging out of a parent or guardian's insurance plan
- Divorce or legal separation and losing health insurance
- Death of a family member
- Increase or decrease in household income
To qualify for a SEP due to losing health coverage, you must meet certain timing requirements. If you have already lost your coverage, you must pick a new plan within 60 days of the date your coverage ended. If you know you will lose your coverage in the future, you must select a new plan within 60 days before your coverage ends. Additionally, you will need to submit supporting documents within 30 days of picking a new plan. These documents may include a letter from your employer or insurance company confirming your loss of coverage.
It is important to note that losing coverage due to failure to provide required documents does not qualify for a SEP. Additionally, COBRA and retiree health plans are not considered coverage based on current employment, so losing this type of coverage does not qualify for a SEP.
In some states, like Georgia, there may be additional criteria for qualifying for an SEP. For example, in Georgia, you may qualify for an SEP if you have an estimated annual household income below 150% of the Federal Poverty Level (FPL) or are American Indian/Alaska Native (AI/AN).
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Picking a plan and submitting documents
If you have lost or are about to lose your health insurance, you may apply for Marketplace coverage. To do so, you must confirm that the information on your application is true. You may be asked to submit documents to confirm your life change, like a letter from your employer or insurance company that supports coverage loss. Losing qualifying health coverage, moving, getting married, having a baby, or adopting a child are all changes in your situation that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.
To apply for a Special Enrollment Period, you can create an account or log into an existing one on HealthCare.gov. You will then be informed if you need to provide documents. If you do, you will receive notices (letters, emails, or both) telling you which documents to submit. You may also receive a notice from your health insurance company. You will have at least 90 days to resolve the health insurance issue before your plan could end or change. For citizenship and immigration issues, you will have 95 days.
If you have told the Marketplace that someone on your application is a U.S. citizen or U.S. national, or has eligible immigration status, but you don't submit the required documents in time, their health insurance could be terminated. You should log into your Marketplace account and select the application with the data matching issue under "Your applications". You should then follow the directions on the screen for each issue.
It is recommended that you pick a plan first and then submit your documents. You must pick a plan within 60 days before your coverage will end, and submit documents within 30 days of picking a plan. Your coverage will start the first day of the month after your coverage ends and you pick a plan. You can upload documents by logging into HealthCare.gov. You will need scanned copies or clear photos of the documents. Do not send original documents – send photocopies only.
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Involuntary loss of coverage
An involuntary loss of coverage is a qualifying event that triggers a special enrollment period. This means that if you lose your insurance plan for reasons other than your own cancellation, non-payment of premiums, or rescission, you will have the opportunity to enroll in a new health insurance plan. This can be done either through the exchange/Marketplace in your state or off the exchange directly through an insurer.
The coverage you're losing has to be considered minimum essential coverage. For example, if you have a short-term plan, this does not count as a loss of coverage, as short-term plans are not considered minimum essential coverage. However, if you leave your employer, either voluntarily or involuntarily, and lose access to your employer-sponsored health insurance, this is considered an involuntary loss of coverage.
If you know that you will lose your coverage in the future, you must pick a new plan within 60 days before the date your coverage will end. You will then have 30 days to submit the required documents, and your coverage will start on the first day of the month after your previous coverage ends. To prevent delays in starting your new coverage, it is recommended that you send the required documents as soon as possible.
Overall, involuntary loss of coverage provides a safety net for individuals who unexpectedly lose their health insurance, allowing them to maintain continuous coverage without having to wait for the next Open Enrollment Period.
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Losing coverage from your employer
If you lose your job-based health insurance, you can enrol in a Marketplace plan. You will qualify for a Special Enrollment Period to get coverage for the rest of the year. You need to apply for Marketplace coverage within 60 days of losing your job-based coverage. Your coverage can start the first day of the month after you lose your job-based plan.
When you apply for Marketplace coverage, you will receive an eligibility notice. This will tell you if you need to submit documents to confirm your loss of coverage. You may be asked to submit documents to confirm your life change, like a letter from your employer or insurance company that supports your coverage loss. You may also need proof that you lost health insurance through your job.
If you've already signed up for COBRA coverage, find out if you can switch from COBRA to a Marketplace health plan. Contact your employer to learn about your COBRA options. You can also get more details about COBRA coverage from the Department of Labor.
If you decline individual health insurance through your employer, you can enrol in an Obamacare plan through the Marketplace. However, you will most likely not qualify for any subsidies or other financial assistance. You will only be able to qualify for cost savings if your employer-sponsored health plan does not meet the "minimum value standard". This means that if your employer-provided plan does not include substantial coverage (including physician and inpatient hospital services), it doesn't meet the standards.
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Applying for Marketplace coverage
If you have lost your health insurance or expect to lose coverage in the next 60 days, you may qualify for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. Losing job-based coverage is a qualifying life event for a Special Enrollment Period. Generally, you have 60 days following the loss of job-based coverage to apply for a special enrollment opportunity through the Marketplace. If you have advance notice of your coverage loss, you can apply for the special enrollment opportunity up to 60 days in advance.
To apply for Marketplace coverage, you can create an account or log into an existing one on HealthCare.gov. After completing your application, you may be asked to submit documents to confirm your eligibility for the special enrollment period in your Marketplace Eligibility Notice. You will be allowed to select a plan but will not be able to use your coverage until you confirm your eligibility and make your first premium payment. Your coverage will take effect on the first day of the following month after you pick a plan.
When you apply, you must confirm that the information on your application is true. You may be asked to submit documents to confirm your life change, like a letter from your employer or insurance company that supports coverage loss. You will need to have scanned copies or clear photos of the documents. It is best to send the documents as soon as possible after picking a plan to prevent a delay in your coverage starting.
If you lost Medicaid or CHIP coverage, you must pick a plan within 90 days after the date your coverage ended. You may also qualify for a Special Enrollment Period if you lose coverage because you are no longer a dependent, or if your household income decreases and now qualifies for savings on a Marketplace plan.
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Frequently asked questions
Qualifying life events include losing health coverage, moving, getting married, having a baby, adopting a child, or if your household income is below a certain amount.
You may be asked to submit documents to confirm your life change, such as a letter from your employer or insurance company that supports your loss of coverage.
If you will lose coverage in the future, you must pick a new plan within 60 days before the date your coverage will end.
You can visit HealthCare.gov for more information on Special Enrollment Periods and to confirm your eligibility.
