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What are qualifying events for health insurance enrollment?

Keep in mind...
  • There are four common types of qualifying life events that make you eligible for a special enrollment period
  • These are a loss of health coverage, changes in household size, changes in where you live, and other miscellaneous qualifying events
  • You typically have 60 days after the event to enroll in a new plan during your special enrollment period
  • If you feel that you were denied for a special enrollment period when you should have qualified based on a life event, you can appeal the decision
  • If you still do not qualify, you can apply for Medicaid or CHIP at any time

What is a special enrollment period?

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A special enrollment period is a specific time outside of the open enrollment period when you can sign up for health insurance on the healthcare exchange marketplace website. Open enrollment for 2017 began on November 1, 2016, and ended on January 31, 2017.

You are eligible for a special enrollment period if certain qualifying events occurred in your life. You typically have 60 days after the event occurred to enroll in a plan with your special enrollment period. If you do not enroll during those 60 days, you will not get an extension and you will have to wait until next year’s open enrollment period.

If you are starting a new job that offers health insurance, your employer is required to provide you with a special enrollment period of 30 days.

What is a qualifying life event?

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A qualifying life event refers to a major change in your life that makes you eligible for a special enrollment period on the healthcare exchange website.

If you lose your health insurance coverage, including your employer-based plan, Medicaid, Medicare, COBRA insurance, or you are turning 26 and will lose your eligibility to stay on your parent’s health insurance plan, you will most likely qualify for a special enrollment period. If you lost coverage in the past 60 days or expect to lose it in the next 60, you should apply for a special enrollment period.

Changes to your household size that make you eligible include getting married, getting divorced, and a death in the family that results in a loss of coverage.

These changes must have happened in the past 60 days. If you had a baby or adopted or fostered a child, your new coverage will start the day of the event, even if you enroll 60 days later.

If you are moving, you will typically qualify for a special enrollment period. You must prove that you had health insurance for at least one of the 60 days prior to your move. Other qualifying events might include changes in your income, becoming a United States citizen, and several other events.

How do I apply for coverage with a special enrollment period?

You can apply for a special enrollment period online on the healthcare.gov website or by contacting a representative at the marketplace call center who will determine your eligibility for a special enrollment period. You may need to provide documentation to prove your qualifying life event occurred.

If you could not apply for health insurance during the open enrollment period for a reason beyond your control, you might be eligible for a special enrollment period due to complex reasons in very limited circumstances.

Can I appeal the decision if I was denied a special enrollment period?

You can appeal a special enrollment period denial. To appeal this decision, you can write a letter and mail it to the health insurance marketplace headquarters, mail in an appeal request form to this same location, or fax your appeal request.

Do I need a special enrollment period to apply for Medicaid or the Children’s Health Insurance Program?

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Medicaid and the Children’s Health Insurance Program offer free or inexpensive health insurance coverage to many low-income Americans and those with disabilities. You do not need a special enrollment period to apply for Medicaid or the Children’s Health Insurance Program. You can apply at any time and your coverage will start immediately if you are eligible.

If you recently lost your job and your employer-based coverage or there was a reduction in your income, you should consider applying. You can apply for these programs online through the healthcare exchange marketplace website or you can go in person to your state Medicaid agency.

What are qualifying events for health insurance enrollment?

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Qualifying events for a health insurance special enrollment period including losing health coverage, a change in household size, moving to a new location for any of several reasons, and other miscellaneous reasons such as a change in income.

You can apply for a special enrollment period online on the healthcare exchange marketplace website. You typically have 60 days to enroll.

If you wait longer than that, you will have to wait for the next open enrollment period unless you are eligible for Medicaid or the Children’s Health Insurance Program.

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