Do You Qualify for Special Enrollment with Your Health Care Plan?

Do You Qualify for Special Enrollment with Your Health Care Plan?

Not everyone is a fan of change, but sometimes change can be a good thing. And sometimes change is a necessary thing. Especially when it comes to healthcare. Life happens, we know. So just in case something comes up and you have to make a change to your health insurance plan, here’s how to know if you qualify for special enrollment:

For starters, the two terms you really need to know are open enrollment versus special enrollment periods. Open enrollment is that special time of year where you can enroll or switch healthcare plans. Unlike Christmas, open enrollment dates tend to change from year to year, with many typically falling between November and January. To note, Medi-Cal and Medicaid (free or low-cost health coverage for those that have limited income) have open enrollment all year long.

A special enrollment period is any time outside of that open enrollment period. Seriously. The key thing to remember here is that you are only eligible to get or switch coverage for specific life events.

What are these special enrollment life events?

Normally, you cannot make changes to your health plan outside of open enrollment, unless you undergo qualifying life events. Life events include the following: change in income (or change in your job, usually referring to losing job-based coverage), moving to a new state, and changes in your family composition.

Typically, if you have an event that qualifies you for special enrollment, you have 60 days from when the life event occurs to change your healthcare coverage.

Let’s go into a few more specifics:

Loss of Job-Based Coverage

Loss of job-based coverage qualifies you for special enrollment if any of the following occur:

  • Your employer no longer offers benefits
  • You leave your job (either if you were fired or by choice)
  • Your COBRA coverage expires

Changes in Family Composition

You are also eligible for special enrollment if your family size changes:

  • You get married
  • Have a baby or adopt a child
  • You become legally separated or divorced from your spouse (and you lose health insurance because of it)
  • If there is a death that makes you ineligible for your current health plan

Changes in Residence

Apart from moving to a new state, other household moves also qualify you for a special enrollment period:

  • If you are a seasonal worker, you qualify if you have to move to and from different places based on your job
  • Moving to a new home
  • If you are a student, and you move to or from the city or area you attend school

The other big qualifying event is if you become a U.S. citizen. For other questions, our federal government offers a pretty handy hotline that will solve any additional special enrollment questions: 1-800-318-2596.