Understanding Special Enrollment Periods SEP

Special Enrollment Periods allow you to enroll in health coverage or change plans outside of, or during, the Open Enrollment Period for an earlier coverage start date.

You may qualify for a Special Enrollment Period through the Health Insurance Marketplace based on your income or the following situations:

Change in Primary Place of Residence

You (or someone in your household) had a change in your primary place of residence and gained access to new Marketplace health plans.

You may qualify if you move to a new ZIP code or county, to the U.S. from a foreign country or U.S. territory, or to/from where you attend school (if you're a student), live and work (if you're a seasonal worker), or live in a shelter or temporary housing.

Generally, you only qualify if you had qualified health coverage for at least 1 day in the 60 days before the move. This does not apply if you lived in a foreign country or U.S. territory, you're a member of a federally recognized Tribe or shareholder of an Alaska Native Claims Settlement Corporation (ANCSA), or you lived in a service area with no access to qualified Marketplace coverage.

Moves that don't count: Moving solely for medical treatment or vacation does not qualify.

Loss of Health Coverage

You (or someone in your household) lost qualified health coverage, such as:

• Job-based coverage (including if your employer stopped offering it or you no longer qualify),

• Medicaid or CHIP (including pregnancy-related coverage),

• Medicare Part A or Advantage (Part C, not Part B or D),

• Individual coverage that ended due to a reduction in income,

• Individual/group plans that end mid-year, or coverage under a parent's plan when turning 26.

Report the loss up to 60 days before or after (90 days for Medicaid/CHIP).

Change in Household Size

You (or someone in your household) got married, had a baby, adopted a child or placed one in foster care, or gained/were designated as a dependent by court order.

Generally, one spouse must have had qualified coverage for at least 1 day in the 60 days prior, with exceptions similar to moves (foreign country, tribes, etc.).

American Indians and Alaska Natives: 

May enroll at any time if they're members of a federally recognized Tribe or ANCSA shareholders.

Change in Marketplace Coverage or Assistance Eligibility

Includes becoming eligible for cost assistance, becoming ineligible, a change in the amount of assistance, citizenship/national/legal presence status, release from incarceration, tribal status, OR new eligibility due to a move or income change in states without Medicaid expansion.

Enrollment or Plan Error

You were not enrolled or were incorrectly enrolled due to agents/insurers providing wrong information, a Marketplace technical error, incorrect data on HealthCare.gov, or a contractual violation by the plan.

Other Situations

• Eligible for premium tax credit with income ≤150% of federal poverty level

• Denied Medicaid/CHIP after Open Enrollment or >60 days from a qualifying event

• Victim of domestic abuse or spousal abandonment

• Documents sent but coverage ended

• Income <100% of poverty level, immigration status verified but didn enroll

• AmeriCorps member starting/ending service

• Exceptional circumstance (disability, natural disaster, emergency)

• New access to individual HRA or qualified QSEHRA

For Medicaid/CHIP income numbers, visit HealthCare.gov/glossary/federal-poverty-level-fpl.

Why Choose Protect Your Familia?

At Protect Your Familia, we understand that every family is unique. Our goal is to be the trusted insurance agency for families, helping them secure their financial future and well-being. We navigate complex insurance options to ensure you have the right coverage for every stage of life.

The Importance of Health Coverage

Having good health coverage is essential. It doesn't just protect you—but also your loved ones. Imagine being able to face any unexpected situation without worry. The peace of mind that good health insurance provides is invaluable.

How to Navigate the Enrollment Process

The enrollment process may seem complicated, but you're not alone. Our team is here to guide you through every step. From selecting the right plan to understanding terms and conditions, we're with you.

Frequently Asked Questions

If you have questions about your eligibility or the enrollment process, don't hesitate to contact us. We're here to help you make informed decisions.

Contact us for more information: protectyourfamilia.com

For More Information watch our video in our YouTube channel: https://www.youtube.com/watch?v=O9-9VDKZnj4