How To Prove Loss Of Coverage

Losing Your Health Insurance Coverage Triggers a Special Enrollment Period

If you lose your health insurance coverage, you may be eligible for a special enrollment period. This allows you to enroll in a new health insurance plan without risking a gap in your coverage. To qualify for a special enrollment period, you must have lost your coverage due to a qualifying event, and the coverage you are losing must meet certain guidelines. You must also be able to prove loss of coverage to qualify for a special enrollment period.

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Why Do I Need a Special Enrollment Period?

If you lose your health insurance coverage outside of the open enrollment period, you could risk a gap in your coverage. Fortunately, special enrollment periods allow you to sign up for a new policy without having to wait until the following “open enrollment” period to begin.

How to Qualify for a Special Enrollment Period

To qualify for a special enrollment period, you must have a qualifying event. These may include:

Your individual plan or Marketplace plan is discontinued
You no longer live in your plan’s service area (move)
Your COBRA health insurance coverage is ending
Your household income decreases and you now qualify for a subsidy
Losing employer-based coverage
Losing eligibility for Medicaid or CHIP
Losing eligibility for premium-free Medicare Part A
You lose coverage through a family member; this may include circumstances such as death, divorce, turning 26 and no longer being eligible for coverage through a parent’s health insurance plan
Marriage, or gaining a dependent
Becoming a US Citizen or lawfully present resident/residency status change
Employer plan becomes “unaffordable” (government determines affordability)
Others

It is important to note that you are not eligible for a special enrollment period if you lose coverage voluntarily, you stopped paying your monthly premium, didn’t provide requested paperwork to Medicaid, or you didn’t enroll during yours/spouses “open enrollment” period.

The coverage you are losing must be considered minimum essential coverage. These may include employer-based coverage, most Medicaid plans, Medicare Part A and Medicare Advantage plans, and coverage you may have purchased through Nevada Health Link. An exemption to this rule is if you are losing pregnancy-related Medicaid, Medically Needy Medicaid, CHIP unborn child coverage or a non-ACA-compliant grandmothered or grandfathered plan.