You may qualify for a special enrollment period (SEP) to buy coverage through the ACA’s health insurance Marketplaces, if you experience a life-changing event that results in a loss of coverage, such as:
- losing your employer based coverage,
- aging out of your parent’s health insurance coverage, or
- moving to a new state.
During a SEP you have 60 days to shop for, and buy, new health insurance coverage in the Marketplace. You may also add family members to your coverage during a SEP, if you get married, or give birth to or adopt a child.
Recently, the rules around special enrollment have changed by the Department of Health and Human Services (HHS) and there are a few extra steps that you now have to take.
On June 23, 2017, HealthCare.gov began requiring applicants to submit additional information to conduct a pre-enrollment verification of eligibility for a SEP. What this means, is that once you pick a plan the Marketplace will “pend” your enrollment and you will have 30 days to submit documents to confirm your SEP eligibility before you can begin using your coverage. When you submit an application on HealthCare.gov, you will get a notice with a list of documents you can send to provide this confirmation.
As soon as your SEP is verified, the Marketplace will send your information to the health insurance company you chose and your coverage will start based on when your SEP started and when you picked your plan. In some cases, this will be retroactive.
For more information and to see a copy of the various notices you may receive, visit the CMS Center for Consumer Information and Insurance Oversight website.