Open Enrollment is your window of opportunity to sign up for a Marketplace health insurance plan. It usually occurs between November 1 and January 15 but varies by state. If you miss your chance to enroll or change your plan during open enrollment, you might not be able to sign up for a health insurance plan until the next open enrollment period. However, special enrollment periods might offer you a chance to enroll despite missing the deadline.
There are a series of specific circumstances outlined below that qualify for special enrollment. A Special Enrollment Period enables you to sign up for coverage outside Open Enrollment. We’ve put together this article to provide clarity on what circumstances qualify for Special Enrollment Period. Here’s what you need to know.
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. (If you lost TennCare or CoverKids coverage in the past 90 days, you may qualify for a Special Enrollment Period.)
Life Changes
Significant life changes may qualify you for a Special Enrollment Period. Below you will find a list of qualifying life changes.
Household Changes
You may qualify if you or anyone in your household has undergone any of these changes in the past 60 days.
- Gotten married – In this case, coverage will start on the first day of the month after you pick a plan
- Adopted a child, had a baby, or placed a child in foster care – Coverage starts the day of the event
- Lost insurance coverage due to a divorce or separation
- Lost coverage due to a family member’s death
Moving Residences
Unless you’re moving from outside the country, you must prove that you had health coverage for at least one of the 60 days before your move.
- Changing residences to a home in a different ZIP code or county
- Moving into the US from a US territory or foreign country
- Moving to an area to attend school
- Changing location for seasonal work
- Moving to transitional living or a shelter
Loss of Coverage
Job-based Coverage
- You lose employer-provided health coverage through your job or a family member’s job
- Your parent or guardian is no longer able to provide coverage because you are no longer considered dependent.
Individual Health Coverage
You may qualify if you cannot maintain individual coverage for the following reasons.
- Your plan is discontinued
- You move out of the plan’s service area
- Your household income has decreased, and now you qualify for savings on a Marketplace plan.
- Your coverage ends in the middle of the calendar year.
Denied Medicaid or Children’s Health Insurance Program (CHIP) Coverage
- Household income has changed
- Your child aged out of TennCare or CoverKids program
- Your state agency didn’t notify you that you weren’t eligible until after the Open Enrollment period ended.
Other Qualifying Circumstances for Special Enrollment
Many unusual circumstances may qualify you for Special Enrollment. Here are just a few of them.
- Being impacted by a natural disaster
- Becoming a US citizen
- Leaving incarceration
- Gaining membership in a federally recognized tribe
- Gaining status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Starting or ending service as a member of VISTA, AmeriCorps State and National, or National Civilian Community Corps (NCCC)
Discover Your Health Insurance Options
Signing up for health coverage during Open Enrollment is ideal, but life doesn’t always work that way. If you have special circumstances that qualify you for Special Enrollment or need additional guidance, please contact us today! At Get Covered Tennessee, we are here to help you make healthy choices for you and your family.
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