Webinar:
March 2024

Special Enrollment Periods

In this Beyond the Basics webinar presented on March 12, 2024, Claire Heyison, Senior Policy Analyst for Health Insurance & Marketplace Policy, and Jenny Sullivan, Director of Health Coverage Access, revisit important concepts related to marketplace special enrollment periods (SEPs), including the qualifying events that trigger SEPs, eligibility criteria, the timing of coverage effective dates, and SEP verification requirements.

On March 28, 2024, HHS announced it is extending the Unwinding SEP through November 30, 2024 in states that use HealthCare.gov. Previously, the SEP was only available through July 31, 2024. Our SEP Reference Chart has been updated to reflect this change.

Webinar Resources

↓ Presentation Slides (PDF)

↓ Special Enrollment Periods Reference Chart

Webinar

Jump To:

Overview of Special Enrollment Periods 

  • Categories of events that trigger an SEP
  • Timing of SEPs
  • Requirement of prior coverage

Common Events That Trigger a Special Enrollment Period 

  • Loss of other qualifying coverage
  • Temporary SEP for loss of Medicaid/CHIP during “unwinding”
  • Income <150% FPL
  • Changes in household size
  • Changes in primary place of living
  • Changes in eligibility for financial help

Less Common Events That Trigger a Special Enrollment Period 

  • Enrollment or plan error
  • Other circumstances
  • What does not trigger a SEP in HealthCare.gov?

Process for Accessing SEPs 

  • Overview
  • Reporting changes
  • SEPs That Require the Call Center or A Caseworker

SEP Verification 

  • Changes to verification policy
  • Loss of coverage verification
  • Coverage effective date after SVI is resolved
  • Difference between SEP verification, DMI, and ID proofing

Restrictions on Plan Choice for Current Enrollees 

  • Overview
  • SEPs exempt from restrictions on plan selection

Additional Resources

Information from Beyond the Basics:

Community Catalyst

HealthCare.gov/CMS:

Health Reform: Beyond the Basics is a project of the Center on Budget and Policy Priorities designed to provide training and resources that explain health coverage available through Medicaid, CHIP, and the Marketplace. It is aimed at navigators, advocates, state and local officials and others who help consumers get and keep their health coverage.

Stay up to date:

Center on Budget and Policy Priorities

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Washington, DC 20002

Beyondthebasics@cbpp.org

Robert Wood Johnson Foundation

Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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