Special Enrollment Periods and Qualifying Life Events: What You Need to Know Amid COVID-19

Special Enrollment Periods and Qualifying Life Events: What You Need to Know Amid COVID-19

The novel coronavirus (COVID-19) pandemic has severely affected the American workforce, with over 6.6M people filing for unemployment in a single week at the end of March. If you lost your job due to the COVID-19 outbreak, here is everything you need to know in order to get health insurance coverage right now. You may qualify for a special enrollment period based on qualifying life events.

Before diving into specifics, it’s important to understand both Special Enrollment Periods and Qualifying Life Events:

Special Enrollment Period (SEP)

This is a time outside the yearly Open Enrollment period where you can sign up for health insurance. You qualify for a SEP if you have experienced certain life events. Generally, Special Enrollment is a 60-day window that begins on the date of your Qualifying Life Event.

Qualifying Life Event (QLE)

This is a change in your situation, such as:
• Getting married or divorced
• Having or adopting a child
• Death in the family
• Moving
• Turning 26 and losing coverage through a parent’s plan
• Losing eligibility for Medicare, Medicaid or CHIP
• Losing your exiting health coverage, including job-based, individual and student plans

In cases where you know you’ll lose coverage; you can apply for health insurance 60 days before the QLE.

It’s also important to remember that you may need to prove your eligibility for a QLE by submitting documentation. After you submit your application, you’ll find out if you need to provide anything. Further details and instructions will appear on your eligibility results screen and in a notice, which you can download or get in the mail.

What to do if you recently lost your job due to COVID-19

After weeks of deliberation, the Trump administration has decided against reopening the ACA’s Healthcare.gov marketplaces to new customers. This decision, however, will not prevent those who lost their jobs from obtaining insurance.

People who lose job-based insurance already qualify to enroll on the marketplaces, as it’s a QLE, but you are required to provide proof that you lost your coverage.

In many states, you will also be able to sign up for Medicaid, the national health insurance program for low-income people that’s jointly funded by state and federal governments. If your income has been wiped out with the loss of your job, you should check to see if you qualify for this program. Medicaid enrollment takes place year-round and is based on monthly income vs. annual income.

If you don’t have insurance and you live in one of the following states who run their own marketplaces, you can sign up for a plan that is most likely subsidized:

• California
• Colorado
• Connecticut
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New York
• Rhode Island
• Vermont
• Washington State
• Washington DC

According to the Kaiser Family Foundation, more than 4M people who are uninsured would qualify for a subsidized ACA plan that would cost nothing in monthly insurance premiums.

Additionally, if you have children that need health coverage, they may be eligible for The Children’s Health Insurance Program (CHIP). This program provides low-cost insurance to children in families who earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women as well.

Remember, if you are eligible for a SEP, health plans must allow you to enroll regardless of health status, age, gender, or other factors. Marketplace plans cannot end your coverage due to a change in health status, including diagnosis or treatment of COVID-19.

Sources:

https://www.healthcare.gov/glossary/special-enrollment-period/

https://www.healthcare.gov/glossary/qualifying-life-event/

https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/

https://www.medicaid.gov/medicaid-and-you/index.html

https://www.healthcare.gov/blog/coronavirus-marketplace-coverage/

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