Qualifying for ACA Open Enrollment Outside of Regular Periods: Understanding Special Enrollment Periods (SEPs)

The Affordable Care Act (ACA) provides insurance coverage to millions of Americans. Typically, individuals can enroll in ACA health insurance during the annual open enrollment period, which runs from November 1st to January 15th. However, certain life events may qualify individuals for a Special Enrollment Period (SEP), allowing them to enroll in coverage outside of the open enrollment period.

What is a Special Enrollment Period (SEP)?

A Special Enrollment Period (SEP) is a time outside of the open enrollment period when individuals can enroll in health insurance coverage. SEPs are typically triggered by certain qualifying life events that create a need for coverage, such as:

Losing health insurance coverage through an employer or other group plan
Getting married or divorced
Having a baby
Moving to a new area
Experiencing a change in income

Lost Coverage SEP

One of the most common SEPs is the “lost coverage” SEP. This SEP allows individuals who have recently lost their health insurance coverage to enroll in a new plan. The lost coverage SEP generally lasts for 60 days after the loss of coverage.

Note: It’s important to provide proof of lost coverage within 30 days of enrolling in a new plan under the lost coverage SEP.

How to Enroll During a SEP

To enroll in health insurance during a SEP, you can:

Visit Healthcare.gov or your state’s health insurance marketplace website.
Call the Marketplace Call Center at 1-800-318-2596.
Contact a licensed health insurance agent.

When enrolling during a SEP, you will be required to provide documentation that supports your qualifying life event. For example, if you are enrolling under the lost coverage SEP, you will need to provide documentation of your previous health insurance coverage and the date it ended.

Conclusion

Special Enrollment Periods provide individuals with the opportunity to enroll in health insurance coverage outside of the regular open enrollment period. If you have lost coverage, gotten married, or experienced another qualifying life event, you may be eligible for an SEP. Understanding the different types of SEPs and how to enroll during an SEP can help you obtain the coverage you need to protect your health and your finances.