The Ultimate FAQ for Special Enrollment Period

what is special enrollment period

Special Enrollment Period (SEP): it can be confusing and frustrating, but it may also be your ticket to better health insurance after a big life change. Here’s what you need to know.

1. What is Special Enrollment Period?

Every year, you can buy health insurance during the designated Open Enrollment Period (usually November through mid-December). If individuals could simply start and stop coverage whenever they wanted, many people would wait until they got sick or required expensive medical care before buying insurance. OEP restricts when you can buy health insurance in order to maintain a needed balance for health insurance companies. By constraining the time period in which you can purchase health insurance, the amount of money going into and coming out of insurance companies’ pockets remains relatively balanced. This allows insurance companies to maintain a balanced pool of sick and healthy people, keeping the marketplaces stable.

That said, if a major life change leaves you without health insurance during the year, you’re eligible for a Special Enrollment Period (SEP). You can buy a new plan during this time.

2. What qualifies you for a Special Enrollment Period?

To be eligible for SEP, you’ll need proof of a qualifying life event (i.e. a major change to your lifestyle or household). Most eligible events cause you to lose your current health coverage. Examples of qualifying life events include:

  • Losing job-based coverage

  • Having a baby

  • Getting married or divorced

  • Moving to a new zip code or county

  • Getting released from prison  

Get the full list of common qualifying events here.

3. How long do you have to enroll after a qualifying event?

You have 60 days from the date of your qualifying event to get a new health plan.

4. Do I need documents to prove my qualifying life event?

Yes! When you enroll during a Special Enrollment Period, you will be required to provide certain documentation that proves your qualifying event took place. This documentation varies depending on the event (see the full list here), but overall it will need to:

  • Includes an official letterhead, if it’s from a hospital, insurer, or employer

  • Your full name and any covered dependents who are also losing coverage

  • Provide important dates related to the qualifying event

5. I think I’m eligible for Medicaid or CHIP. Do I need a qualifying event to sign up?

You do not! Government health programs, like Medicaid and CHIP, don’t have enrollment periods. If you’re eligible, you can sign up at any time.

6. I missed a premium payment and my plan was cancelled. Is that a qualifying event?

Unfortunately, no. If your plan is cancelled because of a failure to pay, you’ll need to wait until the next Open Enrollment Period to get new health insurance. Keep in mind that most insurance companies offer a grace period (usually 90 days) for late payments. You can also always call your insurance company, explain what happened, and try to negotiate a reinstatement.

7. We’re moving within the same state. Is that a qualifying event?

That depends! If you relocate somewhere with options you didn’t have access to before, that’s considered a qualifying event. You’re also eligible for an SEP if you move to a new county where your current plan is not available.

8. When will my coverage start if I apply during Special Enrollment?

Once you enroll, your health insurance will typically kick in on the first day of the following month. This depends on your qualifying event, though. Some qualifying events (like having a baby) “trigger” your effective date. You can learn more about how this works here.

9. Any secret ways to get around those Special Enrollment requirements?

The only way to obtain insurance in the immediate future is if you have a qualifying event. However, it's not unheard of to, er, "induce" a qualifying event just to get covered… if you're looking for one more reason to pop the question, buy that new home, or quit the 9-5 to follow your dreams and go freelance, maybe now's the time!

10. I have an SEP question you didn’t answer. Who can I reach out to?

We are here to help! Send your burning questions to our licensed enrollment agents here.

Aly KellerComment