Webinar: Special Enrollment Periods

In this Health Reform: Beyond the Basics webinar presented on February 28, 2019, Sarah Lueck, Senior Policy Analyst, reviews the circumstances that trigger a special enrollment period and clarifies changes and updates to the rules surrounding special enrollment periods.

Presentation Slides

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Special enrollment period (SEP) review

  • Timing
  • Eligibility
  • Coverage start date


Events that Trigger a Special Enrollment Period

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Loss of other qualifying coverage (video section, slides)

  • Loss of minimum essential coverage
  • Loss of pregnancy-related Medicaid coverage
  • Loss of medically needy Medicaid coverage
  • Expiration of a non-calendar year plan

Changes in household size (video section, slides)

  • Marriage
  • Birth / adoption / placement in foster care / court order

Changes in primary place of living (video section, slides)

  • Permanent move

Changes in eligibility for financial help (video section, slides)

  • Moving out of the Medicaid coverage gap
  • Current employer plan no longer considered qualifying coverage
  • Newly gaining eligible immigration status
  • Release from incarceration
  • American Indian and Alaska Native (AI/AN)
  • Newly eligible or ineligible for premium tax credits
  • Change in cost-sharing reduction eligibility

Enrollment or plan error (video section, slides)

  • Error/misconduct/inaction
  • Plan or benefit display error
  • Health plan violation

Other circumstances (video section, slides)

  • Being determined ineligible for Medicaid or CHIP
  • Resolving a data-matching issue
  • Survivors of domestic violence
  • Exceptional circumstances

Events that do not trigger an SEP (video section, slides)


Restrictions on Plan Choice for Current Enrollees

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  • Restrictions on Plan Selection
  • SEPs exempt from restrictions on plan selection


Process for Accessing SEPs

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Reporting changes

  • Accessing an SEP

SEP pre-enrollment verification (video section, slides)

  • Process for verifying eligibility for SEP
  • SEPs subject to pre-enrollment verification
  • Documents that can be used to verify SEP eligibility

Additional Resources

Resources | View resources links

SEP Reference Chart | View reference chart

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources