Understanding Special Enrollment Periods and Qualifying Life Events

Benefits administrators need to understand healthcare enrollment when onboarding new employees or helping an existing teammate navigate a big life change. It’s a fairly common misconception that you can only enroll in a new healthcare plan during the Open Enrollment Period, but that’s not the case. There are many situations (aka a qualifying life event) that can make an individual eligible to enroll in a new healthcare period outside of that small window. These are known as Special Enrollment Periods (SEPs).

To better understand how to support your employees if they need to secure health insurance coverage with a Special Enrollment Period, keep reading. 

Special Enrollment Period vs Open Enrollment Period?

The Open Enrollment Period typically stretches from November 1st to January 15th. During this time, you can either renew an existing healthcare plan or switch to a new one. You can also make adjustments to an existing plan during this period. Individuals who want new coverage by January 1st must finalize their healthcare arrangements and pay their first premium by December 15th. Otherwise, if you select a healthcare plan and pay your first premium by January 15th, you can receive coverage by February 1st.

Most people enroll in healthcare during the Open Enrollment Period, but there may be times when enrolling during the Special Enrollment Period is necessary. With a Special Enrollment Period, there needs to be a triggering life event that enables enrollment outside of Open Enrollment.

How Special Enrollment Works

So — what qualifies you for a Special Enrollment Period? These are examples of qualifying life events:

It’s important to note that you need to act swiftly if you want to take advantage of a qualifying event. Depending on the type of Special Enrollment Period you qualify for, you will either have 60 days before or 60 days following the event to enroll in a plan. Job-based health insurance plans come with an automatic Special Enrollment period of 30 days. The good news is, that if you want to enroll in the Children’s Health Insurance Program (CHIP) or Medicaid, you can do so any time. 

Breakdown for Medicare and ACA

You’re likely wondering how long do Special Enrollment Periods last for Medicare and ACA? Applying for Medicare looks different from applying for other healthcare plans under the ACA. What are the key differences between Medicare and ACA Special Enrollment periods? As noted earlier, you normally have 60 days before or after a qualifying life event to enroll in a healthcare plan during the Special Enrollment period. The Medicare special enrollment period is two months.

How to prove a qualifying life event

Understandably, you can’t just claim a qualifying life event to take advantage of the Special Enrollment Period. You may be asked to submit documents proving the life event occurred and will be required to attest that the information you provide on the application is factual.

What should I do if I miss the Special Enrollment Period for Medicare?

If you miss your chance to take advantage of the special enrollment period for Medicare, you need to act quickly to see if you can rectify the situation. It’s a good idea to call the Medicare office to discuss your options. This can also be done if you experienced an exceptional circumstance that may be a qualifying life event but that isn’t listed on the Medicare website. You can call 1-800-MEDICARE (1-800-633-4227) to learn more about your options for getting healthcare coverage outside of the Open Enrollment period. 

How Thatch Can Help

To find out how you can help support all your employees in their journey to securing health insurance coverage, sign up for a free demo of Thatch. We’re happy to learn how you can spend less time managing employee benefits and related issues, all while providing better, more flexible healthcare for all your employees.