Understanding Special Enrollment Periods for Health Coverage
A special enrollment period is a limited time outside the annual open enrollment when you can sign up for health coverage because of a qualifying life event. Losing employer-based health insurance, including COBRA, is a qualifying event.
What You Need to Know
- A special enrollment period lets you enroll in health coverage outside open enrollment after a qualifying life event.
- Common events include losing minimum essential coverage, moving to a new service area, marriage, birth or adoption, and certain immigration or status changes.
- You have 60 days after the event to sign up. If you know your coverage will end, you may sign-up up to 60 days before it stops.
- You will usually need to provide documents that verify the event and the date it occurred.
- Coverage generally starts the first day of the month after you select a plan. Birth or adoption can allow coverage starting on the date of the event if requested.
Qualifying Events for a Special Enrollment Period
These Qualifying Events may give you a special enrollment period.
- Marriage.
- Birth, adoption, or placement of a child.
- A medical child support order issued by a state or federal court.
- A permanent move to a new service area with different plan options.
- Loss of other health coverage due to job loss, divorce, or loss of eligibility for Medicaid or CHIP.
- COBRA coverage ends or your plan is decertified.
- If you are enrolled in a marketplace plan, a change in income or household size that changes your eligibility for premium tax credits or cost-sharing reductions.
Learn more about all qualifying events for COBRA insurance.
Voluntarily Quitting Health Coverage is Not a Qualifying Event for a Special Enrollment Period
Stopping premium payments, letting COBRA lapse, or losing coverage that is not minimum essential coverage does not create a special enrollment period.
If you quit or are fired and lose your employer plan, that loss is a qualifying event. You may elect COBRA to keep the same plan. If you drop COBRA or miss payments, you generally must wait until open enrollment or until COBRA ends.
Many people obtain an individual health plan to avoid a gap in coverage.
When Were Special Enrollment Periods Established?
Special enrollment periods for employer group health plans were established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This law requires group plans to allow enrollment outside the regular open enrollment period after certain life events, including marriage, birth, adoption, or loss of other qualifying coverage. These events typically provide a 30-day enrollment window.
The Affordable Care Act of 2010 expanded and standardized special enrollment periods for individual health insurance coverage. The law generally provides a 60-day window to enroll after a qualifying event and includes federal rules for required documentation, effective dates, and eligibility.
Frequently Asked Questions
A limited time outside open enrollment to sign up for coverage after a qualifying life event, such as losing job-based insurance, moving, marriage, birth, or adoption.
Within 60 days after the event. If you know your coverage will end, you can often apply up to 60 days before it stops.
Quitting or being fired causes a loss of employer coverage, which qualifies. Stopping premium payments or letting COBRA lapse does not create a new special enrollment period.
Documents that show the event and date, such as a termination or COBRA notice, proof of move, marriage certificate, or birth or adoption papers.
Typically the first day of the month after you pick a plan. Birth or adoption can start on the event date if requested. If you enroll before your old plan ends, you can set the new start to the first of the month after the loss to avoid a gap.
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