If you want coverage that meets minimum ACA standards, you have to sign up during the annual open enrollment period unless you have a household income that is less than 150 percent of the federal poverty level, are American Indian or Alaskan Native, or have a qualifying life event that entitles you to a special enrollment opportunity. Some events that trigger a special enrollment opportunity are:
Note that some triggering events will only qualify you for a special enrollment opportunity in the health insurance marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, or your income is at or below 150 percent of the federal poverty line, the marketplace must provide you with a special enrollment opportunity, but insurers outside of the marketplace do not. This is not an exhaustive list of triggering events, and special enrollment periods may be subject to change, while some may only be available through the marketplace call center or not available in some state-based marketplaces. If you don’t see an opportunity listed above on the enrollment website, or if you’ve experienced a change in circumstances you believe might qualify you for a special enrollment period, contact your marketplace. Deadline to Apply When you experience a qualifying event, your special enrollment opportunity will typically last 60 days from the date of that triggering event. Generally, if a qualified individual or his dependent loses minimum essential coverage, then the individual has 60 days before or after the last date of coverage to select a plan. This includes loss of employer-based coverage, Medicaid-related pregnancy coverage, and Medicaid-related medically needy coverage. There are a few exceptions to the 60-day timeframe, including:
Other Restrictions and Requirements If you are enrolled in marketplace coverage and have a special enrollment opportunity to switch to a new marketplace plan, in most cases you are restricted to products in the same metal level as your current plan. When you apply for a SEP, in certain circumstances, the marketplace may ask you to provide verifying documents prior to enrollment for the following qualifying events: loss of other coverage, moving, gaining or becoming a dependent through adoption or court order, marriage, and a Medicaid/CHIP denial. Typically, you will have 30 days to submit the documentation, but check with your marketplace to see what the requirements are during the COVID-19 pandemic. (45 C.F.R. § 155.420(d); CMS, Special Enrollment Periods (SEPs) Information.) |