Health Insurance Blog

Your Guide to Qualifying Events and Special Enrollment Periods

Posted by:
Tim Jackson
February 4, 2016
So now that Open Enrollment for 2016 has come to a close, there are probably a dozen different questions running though your mind.

So now that Open Enrollment for 2016 has come to a close, and you still need to have health insurance, there are probably a dozen different questions running though your mind.  You’re asking yourself, “what are my options?” “Do I even have any options?” “Isn’t there some way around this deadline?” “Why do we even have this deadline?”

Which reminds me of that part in The Emperor’s New Groove where Yzma emphatically asked Kronk “Why do we even have that lever?”

Are you glad you took a moment to relive that perfect scene from one of the most hillarious Disney Movies of all time?  I know I am.

Anyways, back to the subject…whether or not you like it, at this point in time there is nothing we can do about the deadline.  However, if you have what the Health Insurance world calls a “Qualifying Event” then you will still have an opportunity to enroll in Health Insurance this year.  Once you have a Qualifying Event, it will trigger a Special Enrollment Period–or in other words a 60 day period where you will be able to enroll in health insurance outside of the typical open enrollment window.

For more information on this subject, check out another one of our handy dandy blog posts right here:

So there may be options for you, supposing you qualify for a qualifying event.  In fact, even if you did enroll in health insurance during Open Enrollment 2016, you still may qualify to change or review your plan this year.  The simple explanation is this, if you have a qualifying event, you can change your coverage within 60 days of the event.  Or do a happy dance while chanting over and over “I have a Special Enrollment Period!  I have a Special Enrollment Period!!”  I dare you to do that in a public place and see how many funny looks you get.  Ok, now back to the subject:

Her is a list of qualifying events that may apply to you and cause a SEP:

  • Recently lose or are losing coverage. Examples of loss of coverage: Job-based health plan expiring, a divorce, turning 26 and on parent’s coverage, COBRA coverage expiring, medicaid and/or CHIP loss of eligibility, and certain other similar events. (Cancelling the plan or failing to pay the premiums does not count as involuntary loss).  You can enroll from 60 days before to 60 days after losing your other coverage.
  • Recent marriage.  If you get married, you have a 60 day open enrollment window that begins on your wedding day.
  • Permanent move to a new coverage area. A permanent move to a new state will always trigger a special open enrollment period, because each state has its own health plans.  But even a move within a state can be a qualifying event, as some states have QHPs that are only offered in certain regions of the state.
  • Birth or adoption of a child. Important: Child must be born for you to qualify, also it does not cover maternity.
  • An error or problem with enrollment (or non-enrollment) that was the fault of the exchange, HHS, or an enrollment assister. In this case, the exchange can properly enroll the person (or change plans) outside of open enrollment in order to remedy the problem.
  • Employer-sponsored coverage reducing benefits such that it no longer provides minimum value, or becomes unaffordable (defined as requiring the employee to pay more than 9.5 percent of income for just the employee’s portion of the coverage) for the upcoming plan year. In this case, you’ll have access to a special open enrollment window both before and after the date that your employer plan renews (similar to the scenario described above for people losing coverage).
  • Getting eligible immigration status
  • Getting released from incarceration

So if you need health insurance and you do meet the criteria of having a qualifying event, what comes next?

Basically, what happens next is you have a Special Enrollment Period.  Now you can enroll in health insurance even though it’s not Open Enrollment for up to 60 days after the actual event that triggered your SEP.  Not 60 days after you figure out that you probably need health insurance again–unless that is the day of the event.

Can you tell we are excited about this?  If you have a qualifying event, then you should be too.  As part of the Affordable Care Act (Obamacare) you are now able to pick a plan within 60 days of your qualifying event just as if you were enrolling during Open Enrollment.  So what you need to do is figure out if you would qualify for a Subsidy or Tax credit off of your insurance premium price based upon your income.

There are some basic ways to figure out if you qualify.  One of our favorites is to use the Kaiser Health Insurance Subsidy Calculator.  We can also help you if you would rather just call and ask us.  We do this for people all the time.  If you do qualify for a Subsidy, your best bet is probably going to be to go to (which is the government’s sight for all things health insurance) and fill out an application (or update an existing application if you have already applied).  Again, at our office, we love to help clients get through this process.  So please call us and we can help you enroll and pick the right plan for you.

If you do not qualify for a Subsidy, then you probably want to go directly to a health insurance carrier (i.e. Select Health, Humana, Cigna etc.) You may want to use a health insurance agent (like us!!!) to run some quotes for you/your family.  Health Insurance can be very complicated, which is why we suggest using a good agent.

Then you get to enroll in health insurance and reap those benefits—like being able to go to the doctor, and not get fines for not having health insurance.

So in summary:

  • If you didn’t enroll during enrollment and you don’t have a qualifying event: Sucks to be you.  Just kidding, you will have an opportunity next enrollment or if you have a qualifying event at some point this year.
  • Whether or not you enrolled during Open Enrollment and you have a qualifying event, YOU HAVE A SPECIAL ENROLLMENT PERIOD OF 60 DAYS to review your health insurance policy and enroll from the date of the event
  • If you want to review your policy, go the route that you took during Open Enrollment (if you signed up through the Marketplace go there and fill out a new application, if you signed up directly through a carrier go to them and review your plan etc.)
  • If you need to sign up for insurance for the first time, determine if you qualify for a subsidy
  • If you qualify for a subsidy, fill out an application on or call us and we will help you
  • If you DO NOT qualify for a subsidy, go directly through a carrier or call us and we can get you some quotes
  • Reap the benefits of having health insurance, which sounds pretty good to me.

For more information:

This blog was written by Sierra and Marissa

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