There are some life-changing events that come planned well in advance. Other changes come as a complete surprise. Life is a roller coaster of dynamic shifts and pivots that often present challenges, and in some cases, rewards. As we head into the new and hopefully better year, we thought we’d highlight a few of these individual and family dynamic changes as they pertain to qualifying for a special enrollment period. If you missed open enrollment in 2020 or find yourself facing one of these qualifying life events, you will have an opportunity to select a new health insurance plan via the Marketplace.
A Loss in Health Insurance Altogether
If you face a loss in health insurance coverage for any reason, you will have a chance to shop for a new plan via the Marketplace. A loss in coverage is considered a qualifying life event and enables you to take advantage of a special enrollment period. Here are a few common scenarios that translate to a loss in health insurance.
If, at any point in the new year, you find yourself unemployed, you probably face losing your health insurance. Whether you get fired, quit, or are furloughed without benefits, you’ll need to find a way to secure a new plan. Some scenarios allow for COBRA coverage, but with hefty and often unaffordable premiums. But this loss of employment and insurance also qualifies you for a special enrollment period to shop through the exchanges.
Loss of Medicare or Children’s Health Insurance Program Benefits
If you qualify for Medicare or the Children’s Health Insurance Program, you already enjoy affordable health insurance coverage. But if, throughout the year, you find yourself no longer qualified for either, it is considered a qualifying life event. Your financial or career situation may improve, making you no longer eligible for the benefits of CHIP or Medicare. But you’ll also have an opportunity to select a new plan, with a special enrollment period.
Employer Changes to Benefits
Some industries and employers have been hit significantly hard because of the pandemic. As a result, some companies and organizations are choosing to opt-out of their group insurance plans and are moving toward other benefits and insurance solutions, like a Health Reimbursement Arrangement (HRA.) In these cases, those employees formerly covered by a terminated group plan will have a chance to leverage a special enrollment period and shop for a new one.
Personal Life-Changing Events
Sometimes a qualifying life event comes in the form of a personal change. Here are some more personal life-changing events that may come planned or unexpected and would allow you to leverage a special enrollment period.
Whether you’re planning a large event wedding or opting for a small courthouse ceremony, getting married is a significant life-changing occurrence. And joining the assets, finances, debts, and health insurance of two people means also qualifying for a special enrollment period via the Marketplace. You’ll have an allocated amount of time between the date of your union and when the SEP ends. But you’ll have access to browse and select an affordable plan based on the needs of two instead of one.
Facing a Divorce
Similar to getting married, getting a divorce also qualifies for a special enrollment period. During a divorce, the couple looks to split those assets, finances, and debts and will sometimes also need to separate health insurance coverage options. If you are facing a divorce, you, too, will have an opportunity to choose a new health insurance plan that is better suited for your health needs without a spouse.
Moving Out of State
Moving out of state may sound far-fetched to you now. But things can change with work and family and sometimes lead to a new zip code. If you are planning a move to a new state, you would be eligible for a special enrollment period. A move can also mean finding new healthcare providers, which you should consider before selecting a new health insurance plan.
Family Household Changes
Some changes occur under the family household roof that the Affordable Care Act considers a qualifying life event. Here are a few dynamic family shifts that could result in an opportunity to select a new health insurance plan.
Having a Baby
If you are welcoming a new bundle of joy into the world, you will qualify for a special enrollment period. Based on the date of your child’s birth, your enrollment window would begin. And you can then evaluate the health insurance plans on the Marketplace to find the affordable coverage that now includes the tiny person you’re introducing to the family.
Adopting a Child
Adding a child to your family household is considered a qualifying life event, even if that child isn’t a newborn baby. For those of you who have plans to pursue and finalize the adoption of a child, you would also qualify for the special enrollment period that would allow you to purchase a plan that includes coverage for your adopted child. Adding a new member to your family presents new healthcare needs and thus will enable you to find a plan to suit those new needs better.
Death of a Family Member
If someone currently covered under your health insurance plan passes away, you can re-evaluate your options with a special enrollment period. No one typically plans for a death in the immediate family. But accidents happen, and sudden health conditions can arise, especially in today’s pandemic environment. While we certainly hope you don’t have to qualify for a special enrollment period for this qualifying life event, you may take solace in knowing it’s an optional provision if ever needed.
If you find yourself having one or several of these expected or unexpected life-changing events, you’ll be able to revisit your health insurance options with a special enrollment period. To learn more about qualifying life events or to browse the Marketplace for a new plan during a SEP, start with W3LL. You can calculate valuable premium tax credits, compare plans, and find affordable coverage at no extra charge.
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