ComPro – Special Enrollment Periods

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Special Enrollment Periods

It’s the time of year when there are lots of life changes—graduation, new jobs, moving, weddings, and retirement. All of these “qualifying life events” can trigger new options for health insurance. It’s called a Special Enrollment Period (SEP) and it allows you to enroll in new coverage or change existing coverage. This applies across all benefit platforms—employer provided health insurance, individual health insurance plans, and Medicare. The timeframe allowed to make a change will vary.

Here’s a quick overview:

Graduation: If you lose your health insurance as a result of graduating, you will be eligible to enroll in a new plan. If you are insured on your parents’ plan, your coverage may be able to continue until you are 26 or choose to enroll in coverage offered by an employer. This is not always true, so be certain to check it out.

New job: A new employer that offers health insurance benefits will usually have a waiting period before you are eligible to join the plan—typically 30 to 90 days. You may need temporary coverage during the waiting period. If you just left a job with benefits, you may be eligible for COBRA. It can be expensive, but may be necessary if you have ongoing medical conditions. If the employer doesn’t offer health insurance, you will need an individual policy and will want to find out if you are eligible to enroll through healthcare.gov to lower your premium.

Moving: A move to a new state or a different area of the same state can mean that your old health insurance is no longer available. This is particularly true with individual health insurance and Medicare plans.

Wedding: A new marriage triggers a SEP for both group and individual health insurance plans. You will have 30 to 60 days to add your new spouse to your plan.

Retirement: Access to health insurance is a big factor when making retirement decisions. If you are under 65, you will compare COBRA benefits from your employer to an individual policy. If you are 65 or more, you will probably transition to Medicare for your health insurance benefits.

New baby: Adding a new member of the family qualifies for a Special Enrollment Period. The baby can be added to either parent’s health insurance plan, but must be done within 30 to 60 days of the child’s birth or adoption.

Other loss of coverage: Qualifying events include losing employer coverage due to a job loss; losing spousal coverage due to death or divorce; aging off your parents’ health insurance plan on your 26th birthday; and being notified that you no longer qualify for Medicaid benefits. Once again, you will typically have 30 to 60 days to select other health insurance coverage.

It is always wise to work with a professional health insurance agent that can give you the correct information. You want to understand what your options are so that you can make the best health insurance decision.

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