BROKER BLOG

What do you know about special enrollment?

April 04, 2017
What is the special enrollment period?
Special enrollment can occur at any time during the year outside the open enrollment period. Only individuals and households who have experienced qualifying events outside the open enrollment period may take advantage of special enrollment.
 
Is there a special enrollment period for Native Americans?
There is no special enrollment period for tribal members. Native Americans may enroll in health insurance through the Exchange at any time during the year. They are not limited to open or special enrollment periods.
 
What are qualifying events for special enrollment?
Qualifying events include but aren’t limited to:
  • Loss of employer-sponsored coverage
  • Loss of coverage on parent’s plan due to reaching age 26
  • Loss of coverage due to divorce
  • Marriage, childbirth or adoption
  • Moving out of the original coverage area
  • A change in financial status that may affect eligibility for premium subsidies
View more details about qualifying events here.
 
Are there extraordinary special enrollment circumstances?
Yes. Exceptional circumstances may include but aren’t limited to:
  • A serious medical condition or natural disaster that prevented timely enrollment
  • Misinformation, misrepresentation or misconduct by an insurance company, navigator, certified application counselor, or agent or broker that resulted in an individual not getting enrolled or being enrolled in the wrong plan
 
How long does the special enrollment period last?
Those taking advantage of special enrollment must do so within 60 days following their change in family status or loss of other health coverage.
 
How does someone enroll?
As a broker, you can help individuals through the special enrollment process.
For those who already have a plan through the Exchange:
Visit HealthCare.gov Reporting Changes.

For those who need to enroll in a new plan:
Visit HealthCare.gov/screener