An open enrollment period is a yearly period of time when people are able to enroll, re-enroll, or make changes in a health insurance plan for the upcoming year. Typically this period takes place from November 1st through December 15th. The open enrollment period for the year 2020 is over. But if you still need insurance, there is no need to fret. There are exceptions in many cases that may qualify you for a Special Enrollment Period (SEP).
Special Enrollment Period
A Special Enrollment Period is a time period besides the Open Enrollment Period to sign up for health insurance for those that qualify. There are several situations that allow you to qualify for a SEP. These situations are not applicable with Medicaid and the Children’s Health Insurance Program (CHIP). Rather, these are available for enrollment year-round. In the case that these situations reflect your current situation, you may have 60 days before or after the event to enroll in a new insurance plan. It is important to note that in the case that this window is not acted on quickly enough, you will need to wait until the next Open Enrollment Period in order to apply for a qualifying health plan (QHP).
Eligibility Requirements
Certain life events allow people to qualify for the Special Enrollment Period. For example, these may include losing health coverage, marriage, having a child, or even moving.
Changes in the Household: Children & Marriage
If you or anyone in your household has, in the past 60 days, gotten married, had a baby, adopted a child, or placed a child in foster care, you may qualify. In the case of marriage, a plan must be picked by the last day of the month. In cases relating to children, coverage can begin the day of the event. This still applies even if the enrollment occurs up to 60 days afterwards.
Changes in the Household: Divorce & Death
In the case that a divorce or legal separation results in the loss of health insurance, those negatively affected may qualify. Additionally, eligibility is extended in the unfortunate case of the death of someone within the Marketplace plan that leaves those surviving no longer eligible for their current health plan.
Changes in Residence
It is important to note that you must be able to confirm that you had health coverage for one or more days during a 60 day period before your move. Furthermore, changes do not apply for those moving to a territory or foreign country. Household changes that qualify for the SEP are:
- Moving to a new zip code or county
- Moving into the US from a foreign country or US territory
- Moving to or from school as a student
- Seasonal workers moving to or from the area of work and residence
- Moving to or from a shelter or transitional housing situation
General Loss of Health Insurance
In the case that you or someone within the household will lose qualifying health coverage within the next 60 days, or already has lost coverage within the past 60 days, you may qualify for a SEP. Specifically, the following types of coverage losses may qualify for SEP:,
- Loss of job-based coverage
- Loss of personally bought individual health coverage
- Eligibility for CHIP or Medicaid
- Eligibility for Medicare
- Loss of coverage through a family member
Help Through Your Employer
In this case, it is possible to receive help from your employer to cover the cost of coverage and, in some cases, qualify for the SEP. Qualification is based on whether you, or anyone within the household, are given access to an individual coverage HRA (ICHRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) within a 60 day period before or after your loss of coverage.
Additional Qualifications
In addition to the above-stated qualifications, there are other additional, miscellaneous circumstances which may help you qualify. If you recently became a U.S. citizen or gained membership with a federally recognized tribe, you may qualify for a SEP. This also extends to those with a status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder. For those just starting or ending their service as an AmeriCorps State and National, VISTA, or NCC member, there is also the possibility of qualifying. Lastly, those recently leaving incarceration also qualify. These may not cover all the possible qualifying circumstances, so if you think you may qualify, visit healthcare.gov/screener.
Where To Apply For the Special Enrollment Period
The application for the Special Enrollment Period can be filled out online at the healthcare.gov webpage that we linked above. Once at the page, it will prompt you to create an account. After this account is created, you can fill out the application and see if you qualify.
Year-Round Enrollment Opportunities
In addition to the Special Enrollment Period, there are programs that have Year-Round Enrollment Opportunities. Both Medicaid and the Children’s Health Insurance Program (CHIP) have Year-Round enrollment and provide free or low-cost health insurance. But unlike ACA plans acquired through the Marketplace, these programs do have certain qualifications that must be met in order to obtain coverage. Medicaid and CHIP are available to low-income families and children, pregnant women, the elderly, and people with disabilities. Each state might have different qualifications that must be kept in mind.
CHIP
The Children’s Health Insurance Program (CHIP) provides insurance coverage for children from families that earn too much to qualify for Medicaid, as well as some pregnant women. CHIP is provided by all states and works in conjunction with the local Medicaid program. Because of this, each state has its own qualifications and rules for who can be covered. The good news is that it’s a rolling enrollment period, meaning that applications can be submitted at any time in the year. Submitting an application, whether directly for CHIP or Medicaid, is the best way of knowing whether your child qualifies for coverage.
Benefits and Coverage
As CHIP is run by the states, the benefits do vary from state to state; but all plans do come with comprehensive coverage. Comprehensive coverage provides the following:
- Routine check-ups
- Immunizations
- Doctor visits
- Prescriptions
- Dental care
- Vision care
- Laboratory services
- Emergency services
- X-ray services
- Inpatient and outpatient hospital care
For additional benefits and details, it’s best to check with your state’s CHIP program.
Cost
Generally speaking, routine “well child” doctor and dental visits are free with CHIP. For other services, as previously stated, there is a lot of variety due to the fluctuation in how states run the program. Some states might have copayments that you are responsible for, and others may charge a monthly premium. Luckily, there is the consistency statewide that you will never have to pay more than 5% of your family’s yearly income.
Medicaid
Medicaid, similar to CHIP, provides free or low-cost health coverage to low-income Americans, families, pregnant women, the elderly, and those with disabilities. Some states have even expanded their eligibility to automatically cover all those that fall below certain income levels. Most people think that eligibility for Medicaid is only about income, that isn’t always the case. Even if you get disqualified based on income, it’s still worth it to apply. Other factors can come into play in your benefit, depending on your state. Fortunately, Medicaid also has a rolling enrollment period, so you can apply any time.
Benefits and Coverage
Although benefits and coverage will change from state to state, there is consistency in providing coverage for the categories previously stated. To reiterate, these include some low-income people, families, pregnant women, the elderly, and those with disabilities. There are federal guidelines in place to provide a baseline of comprehensive coverage, but for additional details on benefits, it is best to check with your local state agency.
Cost
Cost is hard to define for Medicaid as the price will be affected by the state’s programs. Some states pay for the care directly, meanwhile others go through private insurance companies. However, the state decides to go about providing this care will have an impact on the cost; but the point is to always provide low-cost coverage.
Where To Apply For CHIP and Medicaid
There are currently two ways to apply for CHIP. You can apply over the phone at 1-800-318-2596 (TTY: 1-855-889-4325). You can also apply by filling out an online application through the Health Insurance Marketplace, which will alert you if you qualify. After being chosen as eligible, the information will be transferred to the local state agency for enrollment. This second application can be used to apply for Medicaid as well. In the case of a Medicaid application, it will also inform you if you qualify for an individual insurance plan with savings. Alternatively, you can apply for Medicaid directly through your state’s Medicaid agency.
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