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Posted Aug 25, 2017 by Jenifer Dorsey

How the Obamacare Special Enrollment Process Has Changed

Need an Obamacare plan right now? Be ready to prove you qualify.

As you may have heard, new regulations for special enrollment periods (SEPs) began to take effect earlier this summer. As a result, all consumers who seek an SEP in states served by HealthCare.gov must provide pre-enrollment verification proving their eligibility. The first phase of this requirement was implemented in June, and the second and final phase rolled out this month.


Need Short-Term Coverage?

Shop Temporary Plans[1]


Looking for Long-Term Benefits?

Shop Hospital Indemnity Plans[2]


In case you need a refresher, special enrollment periods are set amounts of time during which you can buy an Obamacare plan outside the annual health insurance open enrollment period. They are triggered by what the Affordable Care Act considers a qualifying life event, and now if you or anyone in your household experiences the following situations, you may need to provide supporting documents to prove you qualify:


1.     Loss of qualifying health coverage (i.e., minimum essential coverage) such as job-based coverage, Medicaid or Children’s Health Insurance Program (CHIP) coverage, Medicare or dependent coverage through a parent’s plan

2.     Change in household size due to marriage, having or adopting a child, placing a child for adoption, or gaining or becoming a dependent due to a child support or other court order

3.     Change in primary place of living as a result of moving to a new home in a new ZIP code or county, to the U.S. from a foreign country or U.S. territory, to or from the place you attend school, to or from the place you work seasonally, to or from a shelter or other transitional housing

4.     Change in eligibility for Marketplace (i.e., HealthCare.gov) or help paying for coverage due to income, immigration status, release from incarceration or gaining or maintaining status as a member of a federally recognized tribe or Alaska Native Claim Settlement Act (ANCSA) Corporation shareholders

5.     Enrollment or plan error due to misinformation, misrepresentation, misconduct or inaction of someone working in an official capacity to help them enroll (e.g., insurance company, navigator); a technical error or other Marketplace-related enrollment delay; or wrong plan data displayed on HealthCare.gov when coverage was selected

6.     Other situations, including being deemed ineligible after you applied for Medicaid or CHIP during open enrollment or after a qualifying life event, victims of domestic abuse or spousal abandonment who want to enroll themselves and any dependents in a health plan separate from their abuser or abandoner, AmeriCorps service members starting or ending AmeriCorps service and more

This list represents a general overview. Please read the CMS document Understanding Special Enrollment Periods for additional requirements and details.

For help determining whether or not you qualify for special enrollment, you may want to work with a health insurance producer or contact your state’s ACA exchange.

Not eligible for an SEP? 

Consider coverage options that are available year-round, including short term health insurance or supplemental coverage such as a hospital indemnity plan.


Get a Short Term Quote


Be aware that these are not ACA plans, and applicants for these plan types are subject to certain eligibility criteria; however, short term health insurance does provide temporary benefits that can help you pay for unexpected medical expenses until your next Obamacare plan begins, and hospital indemnity coverage provides supplemental fixed benefits for covered hospitalization, surgery, chemotherapy and radiation services—you can keep a hospital indemnity plan even after your next Obamacare plan begins.


What Will Hospital Indemnity Cost?


Need help? Call the number at the top of your screen to ask questions and discuss your short- and long-term health benefits options with a certified advisor from healthedeals.com.


Legal Disclaimers

[1] This plan does not qualify as minimum essential coverage.

[2] This plan does not qualify as minimum essential coverage.