Do I qualify for a special enrollment period?

You might be eligible for a special enrollment period if one of these qualifying events happens to you — and it’s within a certain timeframe.


Once the open enrollment period is over, you’re locked into your health insurance choices for a whole year—or are you?

In most cases, you won’t be able to change your health insurance selections. However, there are some special circumstances, called “qualifying events,” which give you some flexibility to make changes to your plan during a special enrollment period. Here’s what some of those qualifying events are and what they mean for your health insurance.

Marriage is a common qualifying event. As you’re planning your big day, don’t forget to add health insurance to your to-do list. Do you want to be on your spouse’s plan? No problem. Want to each keep your own health insurance plans? Or switch kids from your insurance to your spouse’s? You can do that too. This may also be a chance for you to rethink your HSA and FSA contributions if children or step-children will be affected by the nuptials.

Divorce, like marriage, is also a common qualifying event. However, the rules for this may vary by state. If you lose your existing health insurance because of a divorce, you may qualify for a special enrollment period so you can get your own insurance. If you have kids, your insurance choices may be affected by which parent will be claiming the child(ren) as dependents on their tax returns.

Having a child can drastically change your life, your finances, and your health insurance plans. This is true whether you have a biological child or you adopt a child. You have 60 days from the event date (birth date or adoption date) to add the newest family member to your insurance.

Job loss is an unfortunate incident that can open up a special enrollment period. If you or your spouse have lost your job in the last 60 days, or if you expect to lose your job in the upcoming 60 days, you can enroll in Marketplace health insurance.

Becoming a U.S. citizen means you can now participate in dozens of actions you previously couldn’t, such as voting, getting a passport, and, yes, getting health insurance (at least on Marketplace; some employers will offer health insurance to non-citizens through work). If are a lawfully present immigrant and your annual income is at or below 150% of the federal poverty level and you don’t qualify for Medicaid, you may be eligible for a special enrollment period to get Marketplace health insurance.

Your health insurance through your employer becoming unaffordable opens a rare special enrollment period. Even with insurance, healthcare costs can be extremely high. As employer health insurance plans change and the cost of living continues to rise, you may still find yourself with steep medical bills. Under a plan through your employer, you shouldn’t be paying more than 9.12% of your household income as your part of the insurance. The plan should also cover at least 60% of total allowed costs for a standard population to be considered “affordable.” If your current plan through your employer isn’t meeting these standards, you may be eligible to apply for a Marketplace plan.

If any of the above situations happens to you, Select Health can help. We have resources listed for the states of Utah, Idaho, and Nevada. Learn more about special enrollment periods and Medicaid plans to help keep you covered.

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