Special Enrollment Period aka “SEP”

Have you heard the term “SEP” going around?  Are you wondering what it is?  An SEP is a Special Enrollment Period that allows you to enroll in and/or make changes to your Health Insurance Plan outside of the Annual Enrollment Period.

Without a qualifying, life-changing event, it is impossible to purchase health coverage in the United States.  So what counts as a qualifying event?  It depends on if you are eligible for Medicare or a Major Medical insurance policy.

 

Common “triggers” for Medicare recipients include:

  • Loss of Group Coverage or Cobra Benefits
  • Loss (or eligibility) of Medicaid benefits
  • Qualify for Low Income Subsidy
  • Move out of your plan’s service area
  • Move into or out of a Skilled Nursing Facility or Long Term Care Institution

Common “triggers” for Major Medical recipients include: 

  • Loss of coverage in the last 60 days
  • Marriage
  • Child Birth
  • Adoption
  • Divorce
  • Death of a family member on your current plan  
  • Move out of your plan’s service area

You typically have 60 days to make changes to your plans but the sooner the better.  Once your time has elapsed, you will have to wait until the next Annual Enrollment Period or another life-qualifying event before you have another chance for change. 

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