What Are Special Enrollment Periods? (Or "I Missed Open Enrollment, Can I Still Get Marketplace Insurance?")

If you missed Open Enrollment on the Marketplace, you may be wondering if you can still get healthcare.

The answer is a Definite Maybe.

Are you eligible for Medicaid? Medicaid enrollment is always open, you can apply anytime.

Check to see if you are income eligible by clicking here. If you are not sure about your tax household size or how to calculate your income, give us a call (734-544-3030) and we can help you. There are also many blog posts on this website about eligibility and special circumstances. Search for self-employment, college/teens, income, or your circumstance. There may be a blog post specifically for you!

If not, here are the most common reasons people qualify for a Special Enrollment Period.

NOTE: Generally, Marketplace special enrollments last 60 days (not quite two months) from the change in status. Most employer special enrollments only last 30 days.

Loss of Health Care/Medicaid Denial

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If you are losing your health care, there are options. If your income is decreasing (loss of job, job change, adding a new member to your household), you maybe eligible for Medicaid. If you are losing your healthcare from your job but are over income for Medicaid, you will be eligible for a 60 day Special Enrollment Period on the Marketplace.

If you are losing Medicaid because your income is now higher, you probably have two choices. First, if your employer offers affordable health insurance, you need to enroll in your employer plan. Loss of coverage creates a 30 day Special Enrollment Period with your employer. Employers are not always aware that you qualify for a Special Enrollment Period when you lose other health coverage. This US Department of Labor document clarifies the policy.

You and your spouse may be be eligible for employer insurance but your children may stay eligible for Medicaid/MIChild, which has higher income limits for children. If your employer insurance is not affordable (official explanation of affordable), the second option is a 60 day Special Enrollment Period on the Marketplace. The 60 day period starts the day you lose your coverage.

Change of Immigration Status

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If you are lawfully present in the US, you may qualify for Medicaid or Marketplace insurance. If you are income eligible for Medicaid and have been here for 5 years, you are now eligible for full Medicaid. Apply for Medicaid and cancel the Marketplace. If your immigration status has changed, for instance if you had a work permit renewed or you got a permanent residence card, you qualify for a 60 day Special Enrollment Period on the Marketplace.

Divorce, Birth and Death

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Divorce, Birth and Death all create special enrollment periods and may change your tax household and income. For the Marketplace, any of these events creates a 60 day Special Enrollment Period from the date of the event.

Moving

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When you move from one county or state to another, you qualify for a Special Enrollment Period if you had health care at your previous address. You can apply for the special enrollment period before your move date.

Turning 26

If you are covered under your parent’s health care, when you turn 26 you will lose that coverage. Some employer plans will cancel you on the day of your birthday and some cancel you at the end of your birthday month. Occasionally they will continue your coverage until the end of the year. You can use the “loss of coverage” special enrollment period starting from 60 days before you lose coverage until 60 days after you lose coverage. Enrollment can start as early as the day after your coverage has been lost.

I was auto-enrolled in last year’s plan. What do I do?

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If you failed to update your application on the Marketplace and were auto-enrolled into your 2018 plan, you should still go in and update your application. To update your application, click on the 2019 application and select “report a life change” from the menu on the left side of the page. Update your application and your tax credit will be accurate for 2019. Unless you qualify for a Special Enrollment Period, you will not be able to change your plan, but at least you will have health care for 2019.


If you have questions, call us. We Help People figure it out. 734-544-3030.

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