Do You Qualify for a Special Enrollment Period (SEP)?


On March 1, 2020, the Federal Emergency Management Agency (FEMA) declared a national emergency due to the Coronavirus Disease 2019 (COVID-19). Consumers who lost qualifying coverage since January 1, 2020, and missed the deadline to enroll in Marketplace coverage due to the COVID-19 national emergency may now qualify to enroll in Marketplace coverage through a Special Enrollment Period (SEP).


Consumers who were unable to enroll in coverage during Open Enrollment for Plan Year 2021 due to the COVID-19 national emergency may be eligible to enroll in coverage through a Special Enrollment Period (SEP).


Consumers who lost qualifying health coverage in the past 60 days OR who expect to lose coverage in the next 60 days qualify for an SEP. In addition, consumers who lost coverage more than 60 days ago, but since January 1, 2020, and didn’t enroll sooner because they were impacted by the COVID-19 national emergency, may still qualify for an SEP.


What are the Qualifiers?


If you lost your job-based health plan: You may qualify for a Special Enrollment Period if you lost health coverage through your employer or the employer of a family member in the past 60 days OR you expect to lose coverage in the next 60 days, including if you lose health coverage through a parent or guardian because you're no longer a dependent. In addition, you may qualify for a Special Enrollment Period if you lost health coverage through your employer more than 60 days ago but since January 1, 2020 and were prevented from enrolling in health coverage due to the national emergency on COVID-19.


Note: Since FEMA declared an emergency due to COVID-19, if you lost coverage more than 60 days ago, you only qualify for a Special Enrollment Period if you missed the deadline to enroll due to being impacted by the national emergency on COVID-19. Voluntarily dropping coverage doesn't qualify you for a Special Enrollment Period unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.

  • If your employer reduced the hours you work and you’re enrolled in a Marketplace plan: Update your application immediately within 30 days to report any household income changes. You may qualify for more savings than you’re getting now. Learn how to report changes.

  • If you were furloughed: In some situations depending on the status of your health coverage from your employer, you may qualify for a Special Enrollment Period. You may be eligible for a premium tax credit to help pay for Marketplace coverage too. Create an account or log in to start your Marketplace application to find out if you qualify.

  • Need help estimating your income? Use this income calculator to make your best estimate.

  • If you have COBRA continuation coverage:

  • If you’re entitled to COBRA continuation coverage after you lost your job-based coverage, you may still qualify for a Special Enrollment Period due to loss of coverage. You have 60 days after your loss of pre-COBRA job-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you end your COBRA continuation coverage, or if you didn’t accept it to begin with.

  • If you're enrolled in COBRA continuation coverage, you may qualify for a Special Enrollment Period if your COBRA continuation coverage costs change because your former employer stopped contributing, so you have to pay full cost.


If you lost your job, but didn’t also lose health coverage, because your former job didn’t offer coverage: You generally won't qualify for a Special Enrollment Period. By itself, a job loss (or a change in income) doesn't make you eligible for a Special Enrollment Period to enroll in Marketplace coverage.


Source: www.healthcare.gov



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