What Is a Special Enrollment Period?
Normally, you can only make changes to your health insurance coverage during specific times of the year or after experiencing a significant life event. Unless you qualify for a Special Enrollment Period (SEP), changes to your health insurance can only be made during annual enrollment periods, such as:
- Annual Election Period (AEP) for Medicare: October 15 to December 7
- Open Enrollment Period for Affordable Care Act (ACA) plans: Typically November 1 to January 15, though this may vary by state
- Your employer’s open season, which is determined by your employer
- Special enrollment periods add flexibility for those who need to adjust their coverage due to changing circumstances
Common Triggers for a Special Enrollment Period
You may qualify for an SEP if you experience any of the following life events:
- Losing employer group coverage
- Turning 65 or gaining Medicare eligibility
- Changes in Medicaid status
- Moving from one county or state to another
- Turning 26 and losing coverage under your parents’ insurance
- Marriage or divorce
These opportunities allow you to update your coverage as your life circumstances evolve. In addition to these triggers, there are federally mandated SEPs declared by the Centers for Medicare and Medicaid Services (CMS) based on local, state, or federal conditions.
Federally Declared Special Enrollment Periods
CMS can declare SEPs in response to events such as severe weather events like hurricanes, tornados, or wildfires and public health emergencies like the COVID-19 pandemic. These declared SEPs are temporary, with fixed start and end dates, though they are sometimes extended based on the situation.
What Can You Do During a Special Enrollment Period?
The specific options available during an SEP depend on the circumstances, but typically, you are allowed to make one change to your coverage. For Medicare, this could include:
- Enrolling in a Medicare Advantage plan
- Switching from one Medicare Advantage plan to another
- Dropping Medicare Advantage
- Switching from one stand-alone prescription drug plan to another
It’s important to note that Medigap (Medicare supplement) rights are generally not affected by federally declared SEPs.
For those under 65, an SEP allows you and eligible family members to enroll in individual health insurance plans or switch plans. However, in most cases, an SEP does not allow changes to your employer group plan if multiple plan options are offered. You may, however, be able to join or leave your employer’s group plan if you missed their open season or need to make changes to your dependents’ coverage.
Need Help Navigating a Special Enrollment Period?
If you’re looking to make changes to your health insurance or believe you qualify for an SEP, contact United Benefits using the form below. Our insurance specialists are here to help you find the best solution for your unique needs.