Are you aware of the SEP – Special Enrollment Period in health coverage plans? If not, then being a US citizen, you must know about it to obtain the benefits. According to reports, over 1.8 million Americans have registered to get new health insurance coverage through the site HealthCare.gov with the 2021 Marketplace SEP between February 15 and July 31, 2021.
Special enrollment periods allow individuals to enroll in healthcare insurance plans or switch plans outside of the annual open enrollment period. Depending on your income status and other circumstances, you may be eligible for special enrollment periods through the Health Insurance Marketplace. Before planning to get the special enrollment through myObamacare, let’s check out the eligibility and other necessary information.
Overview of Special Enrollment and Its Qualifications
The Special Enrollment Period is when you can enroll for health insurance outside of the general Open Enrollment Period. An individual can only qualify for this special enrolment only under certain circumstances.
You may be eligible for a special enrollment period if certain events occur in your life, such as loss of health insurance, sudden relocation, marriage, planning for birth or adoption of a child, or if your overall household income is lower than a certain amount.
This will be decided based on the Special Enrollment Period type chosen. You will have 60 days before or 60 days following the event for the plan enrollment. At any time, an individual can enroll in the Children’s Health Insurance Program (CHIP) or Medicaid coverage. And, for job-based plans, a Special Enrollment Period of at least 30 days is required.
Eligibility for Special Enrollment
An individual can only change or obtain healthcare coverage outside their Open Enrollment if they qualify for the following:
- Sudden life-changing eventsYou are eligible for Special Enrollment if you face certain life-changing events. For example, if you lost your health coverage, which includes Medicaid or CHIP coverage. Suppose you are moving to another place, getting married, planning, or adopting a child. All these will qualify an individual to enroll in Marketplace health plans outside the annual Open Enrollment Period.
- Due to loss of Medicaid or Children’s Health Insurance Program coverageIf an individual recently lost or is about to lose their Medicaid or CHIP coverage. This loss can be due to possible regions, such as the individual’s income being too high or changes that are making them ineligible. In this case, they will qualify to enroll in a myObamacare for Special Enrollment Period. For this, the individual has to create and log in to an account to apply for the coverage.
- Children’s Health Insurance Program, Medicaid, or new Special Enrollment Period on the basis of incomeIndividuals, families, and children with certain incomes are eligible to qualify and apply for the Children’s Health Insurance Program (CHIP), Medicaid, or health insurance plan through the Marketplace. If you qualify on the basis of your estimated household income, you can apply for Special Enrollment from myObamacare at any time.
Special Enrollment Opportunity for People Below Federal Poverty Line
There is a special SEP plan available for people under the Federal Poverty Line. According to the states of HealthCare.gov, individuals who are eligible for premium tax credits and also individuals expecting their annual income to be not more than 150% of the federal poverty level are eligible to apply for SEP – a special enrollment period. This will be $21,870 for an individual and $37,290 for a maximum family of three members.
In case you have missed out on the Open Enrollment period, the Special Enrollment Period will be available for you throughout the year.
Visit the HealthCare.gov site and showcase that you expect your household income to be at or below 150% of the Federal poverty level in the year. Unlike other Special Enrollment Periods, individuals can enroll for subsidies and coverage instantly without providing any proof that they are eligible for this special enrollment opportunity.
However, HealthCare.gov will automatically conduct verification of your income status and estimation, as it does for every applicant for SEP. If, in case, the income amount you have provided on the application is different from the income information confirmed from the Marketplace online, you must provide additional necessary documentation to prove within 150 days.
An individual can sign up for a health coverage plan at any metal level of coverage. However, depending on your income status, it will be figured out that you are eligible for low-cost or uninsured silver plans and cost-sharing subsidies that will significantly reduce deductibles, copays, and out-of-pocket costs.
In case you have registered or signed up during your Open Enrollment Plan, and the income level falls below or to 150% of the Federal Poverty Line, you will be eligible to use this specific SEP to switch or change plans. However, switching is limited to Silver-level plans.
Under conditions of new low incomes, silver coverage plans will show very low deductibles, copays, and out-of-pocket costs. There are state-run marketplaces that also have the better option of offering this low-income Special Enrollment Plan. At myObamacare, you can enroll for this special plan if your income status is the federal poverty line.
Special Considerations to Qualify For Special Enrollment Period
There are qualifying changes and special considerations to apply for Special Enrollments. Below are the situations that will qualify you for a Special Enrollment Period in the United States;
- If you have gained membership from a federally approved and recognized tribe or status as an ANCSA – Alaska Native Claims Settlement Act Corporation shareholder
- If you are becoming or about to become a U.S. citizen
- If you are leaving incarceration
- If you are beginning or ending your service period as an AmeriCorps State and VISTA, National, or NCCC member
Final Takeaways on Special Enrollment Period
The Special Enrollment Period plans are available to make sure every individual in the United States gets the benefits of healthcare insurance coverage. Before applying for the SEP, the individual should be aware of the eligibility or qualifications. It is better to stay updated on the official site before making changes to the plan. If you are looking for special enrollment, myObamacare will help you get easy access.
