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Webinar: Special Enrollment Periods

In this Health Reform: Beyond the Basics webinar presented on March 3, 2016, Sarah Lueck, Senior Health Policy Analyst, discusses the circumstances that trigger a special enrollment period that allows consumers to change or newly enroll in health coverage outside of open enrollment and reviews the timing of coverage effective dates from different triggering events.

Presentation Slides

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Watch the Webinar

What is a Special Enrollment Period?

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Open enrollment

Special enrollment periods (SEPs)

  • Coverage effective dates

 

Events That Trigger an SEP

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SEP triggered regardless of current QHP enrollment (video section, slides)

SEPs for life events (video section, slides)

SEPs for loss of coverage (video section, slides)

SEPs for special circumstances (video section, slides)

  • Moving out of the Medicaid coverage gap
  • Status as an American Indian or Alaska Native
  • Exceptional circumstances
  • Error/misconduct/inaction by the Marketplace, HHS, or non-Marketplace entity aiding in enrollment
  • Coverage effective dates (video section, slides)
  • Example: No longer in the Medicaid coverage gap (video section, slides)
  • SEP for 2016 only: Failed to file a tax return and reconcile APTC for 2014 (video section, slides)

 

Events That Only Trigger an SEP If Currently Enrolled in QHP

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SEPs that apply only to current QHP enrollees

  • Death or divorce
  • Changes in income or household size resulting in being determined newly eligible or ineligible for PTCs
  • Changes in income or household size resulting in change in eligibility for cost-sharing reductions
  • Health plan violation
  • Coverage effective dates (video section, slides)
  • Example: Income change resulting in eligibility change (video section, slides)

 

Events That Do Not Trigger an SEP

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Events that do not trigger an SEP

 

Process for Accessing SEPs

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Reporting changes

Accessing an SEP

Eliminated SEPs (in FFM) (video section, slides)

New verification of SEP triggering event (video section, slides)

 

Q&A


Additional Resources