Whether you buy your own health insurance Opens New Window, get your coverage through an employer Opens New Window, or are eligible for Medicare Opens New Window, you probably have a dedicated time each year when you look at your health care spending, consider the plan options available to you, and renew your coverage or sign up for a different plan for the upcoming year. This is what’s known as open enrollment.
However, there are several qualifying events that allow you to change your coverage at any point in the year. These are known as special enrollment periods (SEP) External Site, and typically follow a major life change like moving outside your coverage area, having a baby, and getting married or divorced. But you may have some questions about SEPs, like: How do I know if I qualify? Is adding parents to health insurance possible? How do I get started?
Get to know each of the qualifying events that allow you to enroll yourself or your dependents in a health insurance plan outside of open enrollment — and how to make the process as easy as possible.
Buy your own health insurance and need to shop for a plan?
Wellmark Blue Cross and Blue Shield has a variety of plans to choose from, designed for individuals and families. Open enrollment for 2022 is currently closed, but you can enroll during a special enrollment period.
SEP qualifying events
Generally, you qualify for an SEP if you’ve had significant changes to your household or residence within the last 60 days. You’ll also qualify for an SEP if you lose health insurance coverage at any point during the year.
Here are some examples.
Household or residence changes:
- Getting married
- Having a baby
- Adopting or fostering a child
- Getting divorced or legally separating
- The death of someone enrolled in your plan
- Certain changes in residence (like moving to a new state or country, going off to college, moving for seasonal work, and going from a shelter to transitional housing)
Loss of health insurance:
- Losing job-based coverage
- Losing eligibility for a plan you purchased yourself
- Losing coverage through a family member (for example, if you are on your parents’ plan and turn 26 years old, or if they experience an SEP that affects your coverage)
- Losing eligibility for Medicare, Medicaid or CHIP
This is not an exhaustive list, and there are some special situations External Site in which you may qualify for an SEP. It’s important to remember that none of these situations arise when you voluntarily drop coverage — unless your household income has dropped significantly or you are eligible for savings on a Marketplace plan.
Changing health insurance coverage with dependents
Any changes you make during an SEP will affect your covered dependents. Typically, dependents include your spouse or partner and the children you care for in your home. But, in special cases, you may have other family members you claim as dependents on your tax return, like an elderly parent or relative for whom you are the primary caregiver.
If you’re wondering, “can I add my mom to my health insurance?” The answer is: it depends on your health plan. Even if you claim a parent or relative as a dependent on your taxes, it is up to your health insurance company to determine whether they will cover that person or not. If they are eligible for coverage through a government program like Medicare or Medicaid, the answer is likely no — but always check with your health plan for the best answer.
Questions about coverage and SEPs?
An authorized Wellmark agent Opens New Window can help you figure out your health insurance options and navigate qualifying events for special enrollment — at no cost to you. Find an agent near you today!
