Speak to an advisor

Health Insurance Special Enrollment is Changing

Health Insurance Special Enrollment is Changing

Posted Jun 26, 2017 by Jenifer Dorsey

5 Things You Need to Know About Getting Coverage Outside of Open Enrollment Now

Suddenly uninsured? If you think you’re eligible for a special enrollment period (SEP) for health insurance, be ready to prove it. New regulations effective June 23, 2017, require 100 percent of consumers seeking an SEP in states served by the HealthCare.gov platform to provide pre-enrollment verification.[1] Previously, about half of consumers requesting an SEP were required to do so.

The crackdown, which stems from a final rule issued April 18, 2017, aims to curb “misuse and abuse of special enrollment periods” by those who decided to enroll in coverage after they find out they need healthcare.[2]


Don’t Qualify for Special Enrollment?

Shop Short-Term Now[3]


Need Coverage for 90+days?

Consider this Long-Term Solution[4]


To help you understand how health insurance special enrollment periods will be handled from now on, here are five key things to know:[5]  


1. You must have a qualifying life event to become eligible for special enrollment. Click here for an in-depth look at qualifying life events from CMS.

2. Documentation will be required. If you have a qualifying life event, you will need to submit documentation that confirms it as requested by the exchange through which you enroll.

3. A deadline will apply. You will have 30 days to provide the requested information.

4. Roll-out of pre-enrollment verification will happen in two phases. The first phase starts June 23, 2017, and the second begins sometime in August.

On June 23, 2017, pre-enrollment verification begins for those who experience the following qualifying life events:

a.) Loss of qualifying health coverage (i.e., minimum essential coverage)

  • Job-based coverage – yours or someone else’s
  • Medicaid or Children’s Health Insurance Program (CHIP) coverage including pregnancy-related coverage and medically needy coverage
  • Some student health plans – check with the school to verify that the plan counts as qualifying health coverage
  • Individual or group health plan coverage that ends during the year
  • Dependent coverage through a parent’s plan

b.) A permanent move

  • Gained access to new health insurance plans due to a change in primary residence and
  • Had qualifying coverage for at least one of the 60 days preceding the date of the move or
  • Lived in a foreign country or in a U.S. territory for at least one of the 60 days preceding the date of the move

In August 2017, pre-enrollment verification will be added for those who experience the following qualifying life events (more details will follow later this summer):

a.) Marriage

b.) Gaining or becoming a dependent through adoption, placement for adoption, placement in foster care, or a child support or other court order

c.) Medicaid/CHIP denial

5. If you can’t prove you qualify for an SEP, you could remain uninsured. And, if you are not exempt from having minimum essential coverage, that means you could owe a tax penalty.

What if I’m denied special enrollment?

It is possible to file an appeal. However, you could find yourself without health insurance coverage and, as mentioned above, may owe a tax penalty if you are not exempt from the Affordable Care Act’s individual mandate.


Find Temporary Coverage


You may need to consider short term coverage, a hospital indemnity plan or another type of health benefits to help pay for healthcare until you have minimum essential coverage.

How do I begin the special enrollment process?

Visit HealthCare.gov to get started. However, for extra guidance and assistance with finding coverage until your new Obamacare plan begins, you may want to work with a health insurance.


Find a Local Agent



Legal Disclaimers

[1] Department of Health and Human Services. 45 CFR Parts 147, 155, and 156. Patient Protection and Affordable Care Act; Market Stabilization. Final Rule. Federal Register. Vol. 82, No. 73. April 18, 2017. https://www.gpo.gov/fdsys/pkg/FR-2017-04-18/pdf/2017-07712.pdf

[2] Ibid.

[3] This plan does not qualify as minimum essential coverage.

[4] This plan does not qualify as minimum essential coverage.

[5] Healthcare.gov. “Enroll in or change 2018 plans - only with a Special Enrollment Period.” Accessed May 23, 2018. https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/