A Special Enrollment Period is a time that you are allowed to sign up for a health insurance plan outside the traditional enrollment periods. In most cases, you are eligible to sign up for Medicare coverage during your Initial Enrollment Period, which generally occurs when a person reaches the age of 65, or qualify under the age of 65 with certain disabilities. The Annual Enrollment Period (AEP) that occurs on an annual basis allows Medicare recipients to make changes in their Medicare coverage from October 15 through December 7 each year. However, there are a few circumstances that allow individuals to seek new insurance policies outside this initial window.
What is a Special Enrollment Period?
Special Enrollment Periods provide Medicare recipients an alternative period during the year in which they can change their coverage without having to wait for AEP. These periods are only available to those who experience certain changes in their life. The life experiences that qualify you for a Special Enrollment Period are very specific.
Who Qualifies for a Special Enrollment Period?
The first group of life changes that qualify for a Special Enrollment Period are changes in household. In order to qualify, one of the following conditions must have occurred within the past 60 days:
- Getting married. If you get married, you can alter your health insurance coverage to accommodate the change. If this is the case, you must select a plan by the last day of the month within 60 days of the marriage. Coverage will then begin the first day of the following month.
- Birthed or adopted a child or placed a child in foster care. In this situation, you are eligible to receive coverage the same day that you apply. You can enroll in care up to 60 days following the event.
- Divorce, legal separation, and lost health insurance because of it. If you lose coverage due to a divorce or legal separation, you qualify for a Special Enrollment Period to find new healthcare coverage. However, if you do not lose coverage due to these events, you do not qualify for a Special Enrollment Period.
- Death. If you have a death in the family of a person that was a member of your plan, and as a result you are no longer eligible for coverage, you qualify for a Special Enrollment Period to obtain replacement health coverage.
You may also qualify for a Special Enrollment Period if you have a change in residence. This can include moving to a home in a different zip code or county, moving to the United States from a foreign country, moving to or from a location where you are a student, moving due to seasonal work, or moving between shelters or transitional housing. However, it is important to note that moving due to vacation or medical treatments does not qualify you for a Special Enrollment Period.
Additionally, a Special Enrollment Period is also available to those who lose their health insurance. This coverage loss may be due to loss of a job, Medicaid eligibility, Medicare eligibility, and coverage through a family member. These losses can have occurred in the past 60 days or be anticipated in the next 60 days to be eligible for a Special Enrollment Period.
There are various other circumstances that may warrant a Special Enrollment Period as well. Some of these can include gaining membership in a federally recognized tribe, leaving incarceration, becoming a new United States citizen and becoming eligible for healthcare coverage, or beginning or ending service as an AmeriCorps State and National, VISTA, or NCCC member.
Maintaining health insurance coverage is critical to ensure the well-being of yourself and your family. If you are faced with certain circumstances that may cause you to lose Medicare coverage or be eligible to sign up for different coverage, it is important to be aware of your options and the timeline you have to act. If you are unsure whether or not your situation qualifies for a Special Enrollment Plan, be sure to reach out to your Medicare representative to gain further clarification.