Purchasing Health Insurance Outside Open Enrollment
Enrolling in a health insurance plan can be a daunting task, and if you aren’t aware of deadlines and “Open Enrollment” guidelines, you may have missed your chance altogether. If you missed Open Enrollment or find yourself in need of health insurance outside of the Open Enrollment period, it doesn’t always mean you have to be uninsured for the entire year.
Before worrying too much, you may want to see if you could still be eligible for a Special Enrollment Period (SEP). The special enrollment period is always within 60 days of a Qualifying Life Event (QLE). If you’ve experienced a Qualifying Life Event within the last 60 days, it triggers a Special Enrollment Period, and you may be able to sign up for (or make changes to) health insurance outside of the Open Enrollment period. Understanding which situations are considered qualifying life events will help you make smart decisions regarding your coverage.
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.
When Can I Make Changes to My Health Insurance Plan?
Open Enrollment in Nevada is from November 1st to January 15th each year. If it is not “Open Enrollment” (the one time each year you can buy health insurance or make changes to your existing health plan), you’ll most likely need a “Life Event” to get coverage.
Situations That Are Considered Qualifying Life Events
If you experience a major life change, then such a change is often considered a qualifying life event. Such life events affect your existing health insurance coverage and can make you eligible to change your coverage during the special enrollment period which is 60 days from the date of your “life event”.
How to Qualify for a Special Enrollment Period
There are several different life events that will allow you to make changes and/or enroll into a health insurance plan. Loss of health insurance due to a change in jobs, loss of eligibility for Medicaid, ending of your Group Coverage, plus many other changes that result in a loss of health insurance, can be considered a life change. Changes to your family “household” (members on your tax return) may also be qualifying life changes. If you got married, divorced, and lost health insurance, had a child, or lost a family member due to death, you may qualify for a special enrollment period. Remember though, you only have 60 days to contact your health insurance agent and make a change.
To qualify for a special enrollment period, you must have a qualifying event. These may include:
- Losing employer-based coverage
- Marriage, or gaining a dependent
- Losing eligibility for Medicaid or CHIP
- Your COBRA health insurance coverage is ending
- Losing eligibility for premium-free Medicare Part A
- Your individual plan or Marketplace plan is discontinued
- You no longer live in your health plan’s service area (you moved)
- Your household income decreases, and you now qualify for a subsidy
- Becoming a US Citizen or lawfully present resident/residency status change
- Employer plan becomes “unaffordable” (government determines affordability)
- You lose coverage through a family member; this may include circumstances such as death, divorce, turning 26 (no longer eligible on parent’s health plan)
- Others
A health insurance agent can help guide you through the process of determining if you are still eligible to apply for health insurance in Nevada. If you’re not, perhaps a short-term health insurance plan may get you by until the next open enrollment period (November 1st through January 15th).
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How to Prove Loss of 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.
To prove loss of coverage, you must be able to provide documents that show you have lost your health insurance within the past 60 days or that you will lose your coverage within 60 days.
Qualifying documents include:
- A letter from your employer
- A letter about COBRA coverage
- A letter showing loss of student coverage
- A letter from your health insurance company
- Documents showing loss of coverage due to divorce or death
- Others
How Income Changes Affect Your Health Insurance?
If your income increases or decreases, this could affect your subsidy amount and eligibility for cost savings programs. Any time you have a change in family size, or change in income, it’s very important you report these to your agent as soon as possible. This allows your agent to continuously match you with an insurance plan that offers the best coverage at the best price for your family.
There are deadlines and coverage consequences with changes. Therefore, it is SO important to keep your health insurance agent up to date on family, income, and life changes. Plus, it helps keep you out of trouble with the IRS.
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Change in Family Status
If you’ve gotten married, divorced (and lost coverage), you’ve had a baby, or a household member has moved out, then you’ll most likely be able to change your health insurance. This would be considered a qualifying life event. Court-ordered dependent changes are also considered a qualifying life event for health insurance.
Change in Residence
Changing where you live could trigger a qualifying life event for health insurance. Moving to a different state, into a permanent residence, and losing your coverage because of the move is considered a qualifying life event. A student who changes residences could also trigger a qualifying life event for health insurance.
Change in Eligibility for Assistance Paying for Health Insurance
If you were eligible for certain types of coverage (such as Medicaid or the Children’s Health Insurance Program), but have recently been denied coverage, then you can shop health insurance plans outside the open enrollment period.
Special Situations That Can Affect Your Health Insurance
Special situations that are outside of the standard qualifying life events previously discussed may take place that would allow you to sign up for health insurance during a 60-day special enrollment period. Such situations are considered complex issues that are subject to review on a case-by-case basis to determine if a qualifying life event has taken place.
Situations That Are Not Qualifying Life Events
Although qualifying life events seem self-explanatory, there are times when such situations would not qualify you to enroll in a health insurance plan with special enrollment period. For instance, while divorce typically is a situation that is considered a qualifying life event for health insurance, it is only such if it results in a loss of health insurance coverage. If there’s no change in your coverage, then this is not considered a qualifying life event.
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 health insurance 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 grandfathered plan.
Contact Nevada Insurance Enrollment to Find Out if You Qualify for a SEP
Unsure of whether your life change or income change qualifies you for a special enrollment period? If you need to report a life change or purchase health insurance during an SEP, call Nevada Insurance Enrollment today and speak to one of our health insurance agents. We specialize in getting you the very best rate you are entitled to, creating custom health insurance solutions for individuals and families in Las Vegas, Northern Nevada, or Statewide Nevada.
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