By .shock on Adobe Stock
Navigating the complexities of health insurance can be challenging. Special Enrollment Periods (SEPs) provide crucial opportunities to secure a health insurance plan outside the standard Open Enrollment Period. Understanding how SEPs work—and what qualifies you for one—can make the difference between being covered or uninsured during a critical time.
What is a Special Enrollment Period?
A Special Enrollment Period is a window of time outside the annual Open Enrollment Period during which individuals can sign up for a health insurance plan or make changes to their existing coverage. SEPs are triggered by specific qualifying life events and typically last 60 days from the date of the event.
According to the U.S. Centers for Medicare & Medicaid Services (CMS), SEPs are designed to help consumers adapt to life changes that affect their health coverage needs. Missing this window could mean waiting until the next Open Enrollment unless you qualify for another SEP.
Common Qualifying Events
Several life events can trigger a SEP for individuals. These include:
- Loss of existing health coverage: Whether due to job loss, divorce, or aging out of a parent’s plan at age 26, losing health insurance opens a SEP.
- Changes in household: Marriage, birth or adoption of a child, or death of a spouse or dependent can all qualify.
- Relocation: Moving to a new ZIP code or county, especially if it impacts available coverage options.
- Changes in immigration status: Gaining lawful presence or citizenship may trigger a SEP.
In some cases, exceptional circumstances—such as natural disasters or errors in enrollment—may also qualify an individual for a SEP. Full eligibility requirements can be found at Healthcare.gov.
Why It Matters for Adults Ages 26 to 64
This age group often experiences significant life transitions, including career changes, family formation, and geographic moves. These transitions may not align with the Open Enrollment Period, typically held from November 1 to January 15 in most states. Without knowledge of SEPs, consumers may delay necessary care or incur high out-of-pocket expenses.
For instance, turning 26 and aging out of a parent’s plan is a major milestone. The Affordable Care Act allows young adults to stay on their parent’s health insurance plan until their 26th birthday. Once that coverage ends, individuals receive a 60-day SEP to find a new health insurance plan.
Similarly, a mid-life job transition, such as moving from full-time employment to freelancing or early retirement, can leave individuals without employer-sponsored coverage. During this time, accessing a SEP ensures continuity of care and financial protection.
How to Enroll During a SEP
To enroll in a health insurance plan during a SEP, you must provide documentation verifying your qualifying event, such as a termination letter, marriage certificate, or proof of relocation.
Once verified, you can compare available plans based on monthly premiums, deductibles, provider networks, and coverage benefits. Financial assistance through subsidies or tax credits may also be available depending on your income. Of course, having the right agent, like those at Empower Brokerage, guiding you in health insurance options and plan reviews is essential. Life changes happen—sometimes unexpectedly—and knowing your rights to secure a health insurance plan during these times can protect both your health and your finances.
If you appreciated reading this article, please read another insightful piece about health plans in Texas.
Have Health Insurance Questions?
We hope that this information on health insurance plans in special enrollment periods is helpful for you.
Insurance is oftentimes overwhelming, and we want to shed light on the industry by answering your questions. Comment below and your question may be the topic of our next post!
If you liked this article, share it with your friends!
Empower Brokerage wants to help you find the insurance coverage you need and help you save money getting it. Stay on top of your health and give us a call at (844) 410-1320.
Get affordable health insurance quotes by clicking here.
See our other websites: