What is a Special Enrollment Period? How to get health insurance after a life change

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When you experience a big life change — planned or not — you may need to revisit your health care coverage.

What is a Special Enrollment Period?

Maybe you lost coverage through your employer, turned 26, got married or expanded your family. These significant changes are called qualifying life events, and they make you eligible for a Special Enrollment Period (SEP). This is a time when you can enroll in health insurance coverage or change your plan outside of the annual Open Enrollment Period (OEP). If you’ve recently experienced a qualifying life event, you likely can enroll in a new plan now.

Common qualifying life events

There are many qualifying life events that make you eligible for a Special Enrollment Period. Here are a few common examples of qualifying life events that would allow you to change your health insurance coverage outside of OEP.

Employment change

You lose health coverage through your employer or a family member’s employer — if you’re a dependent on someone else’s plan. This includes when an employer no longer offers coverage, or if you or a dependent go from full-time to part-time status, resulting in a loss of coverage.

Turning 26

You turn 26 and can no longer be covered by a parent’s health plan.

Moving

You move to a new ZIP code or county where your previous health plan is not offered. This includes moving to or from college or a seasonal residence.

Marital status change

You get married or divorced, causing you to lose health coverage. Once you select a new plan, coverage begins on the first day of the month following enrollment.

New dependents

You have a baby, adopt a child or become a foster parent. Coverage begins on the day of the event, even if you enroll up to 60 days afterward.

Loss of coverage

You lose health coverage if an individual or family Health Insurance Marketplace plan is discontinued, you lose Medicaid or CHIP eligibility or your COBRA plan expires.

If one of these situations applies to you, here are the next steps you can take to gather the necessary documentation, compare plans and enroll in coverage before your Special Enrollment Period’s deadline.

Special Enrollment Period deadlines

In most cases, your Special Enrollment Period gives you 60 days before or after a qualifying life event to update your current health plan or enroll in a new one. Special Enrollment Period deadlines can vary by circumstance, so be sure to check the exact length of your Special Enrollment Period online. If you miss that deadline, you may need to wait until the next Open Enrollment Period to make changes — which could result in a significant gap in coverage.

If you enroll in a new plan, when does coverage start?

In most cases, if you enroll in a new plan before the end of the month, your new coverage will start on the first day of the following month. However, with events like a new baby or the adoption of a child, your coverage will be effective on the exact date of the event.

What paperwork will I need to enroll in a new plan?

You may need documentation to confirm a qualifying life event. It’s a good idea to have the following documents available when enrolling in a new health plan:

• Loss of health coverage — a letter from an employer, insurance company, Medicaid/CHIP program or COBRA administrator showing the coverage end date. Documents may be required for Affordable Care Act (ACA) Health Insurance Marketplace plans within 30 days after selecting a plan, and coverage generally can’t be used until your eligibility has been confirmed and your first premium is paid.
• Turning 26 — proof that coverage under a parent’s plan will end or has ended within 60 days.
• Move to a new ZIP code or county — proof of the new address, such as a lease, mortgage document, utility bill or official mail. In many cases, proof of prior qualifying coverage may also be needed.
• Marriage — your marriage certificate.
• Divorce or legal separation — your divorce decree or legal separation papers — especially if the event caused loss of coverage.
• Birth of a child — the child’s birth certificate or hospital certificate.
• Adoption or foster placement — adoption papers, placement documents or other official court or agency documentation on hand.

Explore health insurance options during your Special Enrollment Period

Many individual or family health plans from Wellmark include $0 preventive care, mental health and virtual care visits when you use an in-network provider. Plus, low copays and thousands of in-network providers and hospitals.

All Wellmark individual and family plans offered on the Health Insurance Marketplace are eligible for a health insurance tax credit (subsidy) — a credit from the federal government for qualifying individuals and their families. Start by reviewing your coverage options and finding an agent.