CBPP Webinar: Back by Popular Demand: Special Enrollment Periods and Exemptions

In this updated webinar – the fifteenth in the Center on Budget and Policy Priorities’ “Beyond the Basics” series of webinars titled “Back by Popular Demand: Special Enrollment Periods and Exemptions” – we focus on the triggers and timing for special enrollment periods, including new guidelines for limited circumstances special enrollment periods for complex cases, and on how people can qualify for exemptions from the penalty for not having health coverage.


Watch the Webinar

Click here for slide deck.


PART I: Special Enrollment Periods (SEP)

Presented by Judy Solomon, Vice President for Health Policy
(Watch here, Slides here)

  • When can someone enroll or switch Marketplace plans outside of open enrollment? (watch here)
  • SEP triggers (watch here)

–  SEP triggered regardless of QHP enrollment

–  SEP triggered only for QHP enrollees

–  2014 SEP for complex cases

  • SEP timing (watch here)
  • Examples of SEP triggers and coverage effective dates:

– Life changes (watch here)

–  Example: Marriage

–  Example: Birth of a baby

–  Example: Permanent move

– Loss of minimum essential coverage (MEC) (watch here)

– Other situations, including additional “exceptional circumstances” SEP (watch here)

–  Example: Loss of hardship exemption

  • What does not trigger an SEP? (watch here)

–  Example: No SEP for income change alone

PART II: Exemptions from the Individual Responsibility Requirement

Presented by Tara Straw, Senior Health Policy Analyst
(Watch here, Slides here)

  • Individual responsibility requirement (watch here)
  • Types of exemptions from the penalty (watch here)
  • Exemptions granted by the Marketplace (watch here)

–  Hardship Exemption: Financial or domestic circumstances (watch here)

–  Hardship Exemption: Lack of affordable coverage (>8% of household income) (watch here)

–  Hardship Exemption: Ineligible for Medicaid based on state decision not to expand (watch here)

  • Exemptions granted by the IRS (watch here)

–  Income below filing threshold (watch here)

–  Lack of affordable coverage (>8% of household income) (watch here)

–  Certain noncitizens (nonresident aliens or undocumented residents) (watch here)

–  Short coverage gap (< 3 months) (watch here)

–  Months prior to effective date of MEC effective on or before May 1, 2014 (watch here)

  • Example: Choosing among exemptions (watch here)
  • Watch Q&A


Additional Resources