Webinar:
May 2023

Special Enrollment Periods

In this Beyond the Basics webinar presented May 4, 2023, Claire Heyison, Senior Policy Analyst for Health Insurance & Marketplace Policy, and Jenny Sullivan, Director of Health Coverage Access, provide an overview of marketplace special enrollment periods (SEPs), including the qualifying events that trigger SEPs, eligibility criteria, and the timing of coverage effective dates.

Webinar Resources

↓ Presentation Slides (PDF)

↓ Special Enrollment Periods Reference Chart

↓ Unwinding Medicaid Continuous Coverage Requirement Resources

American Rescue Plan Act

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 an SEP 

  • Enrollment or plan error
  • Determined ineligible for Medicaid
  • Resolving a data matching issue
  • Other circumstances
  • Events that don’t trigger a SEP

Process for Accessing SEPs 

  • Overview
  • Reporting changes

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

SEP Reference Chart & Other Resources

Unwinding Medicaid Continuous Coverage Requirement Resources

Webinar: Marketplace Appeals (including SEP appeals)

Employer Coverage & Premium Tax Credit Eligibility Tool

Community Catalyst

Community Catalyst Print & Digital SEP Outreach Materials

HealthCare.gov / CMS

Regulations can be found at 45 CFR 155.420

HealthCare.gov SEP information

List of SEPs for complex issues

Information on the temporary “Unwinding SEP” for loss of Medicaid/CHIP coverage

Information on the low-income SEP

Sample marketplace notices

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

1275 First Street NE, Suite 1200
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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