Understanding Special Enrollment Period Shopping For Health Insurance

Justin Brock is the President of Bobby Brock Insurance. Our book Medicare Breakdown on Amazon talks about the different Medigap Plans.

If you need health insurance in a hurry, now could be a great time to get it. Several federal regulations relating to health insurance and Medicare have created multiple special enrollment periods (SEPs) that can allow you to get coverage outside of normal enrollment windows.

What Is A Special Enrollment Period?

Normally, you’re only allowed to make changes to your health insurance coverage during fixed time frames during the year or when you experience a life-changing event. Unless you qualify for an SEP, you can only change your health insurance coverage during the annual enrollment periods:

• Annual election period (AEP) for Medicare—October 15 to December 7.
• Open enrollment period for Affordable Care Act plans—generally November 1 to January 15, but this window can vary by state.

Special enrollment periods can add great flexibility for people who need to change their coverage. Common triggers for enrollment periods include:

• Losing your employer coverage.
• Turning 65, or otherwise gaining Medicare eligibility.
• Moving from one county or state to another.
• Turning 26 and losing coverage from your parents’ insurance.

These enrollment opportunities are always available as your circumstances change. However, there are also other, federally mandated, enrollment options available. These special enrollment periods are declared by the Centers for Medicare and Medicaid Services (CMS) based on certain local, state and federal conditions.

Some of the most common reasons for declared SEPs are:

• Weather events like hurricanes, tornados and wildfires.
• Public health emergencies like the Covid-19 pandemic.

These special enrollment windows are declared for fixed amounts of time. Although they are sometimes extended, they are temporary and always have defined end dates.

Recent Medicare Special Enrollment Periods

Beginning in March of 2020, a series of emergencies were declared due to Covid-19. As a result of these declarations, there have been a number of SEPs available during the course of the coronavirus pandemic. Although the broadest of these special enrollment periods ended in August 2021, it is still possible to make a change in your coverage if you can demonstrate that you were affected by the Covid-19 emergency. This will continue to be true until Covid-19 is no longer a declared emergency.

Affordable Care Act And Individual Insurance Special Enrollment Periods

The same FEMA-declared special election periods apply to individual health insurance policies. Besides these, there is one currently open enrollment opportunity for Affordable Care Act health insurance consumers. In states that use the Federal Insurance Marketplace, individuals with total household income below 150% of the federal poverty limit have a standing special enrollment period. Any members of your household who are eligible for a Federal Marketplace plan, and meet the income requirements, are able to use this SEP.

What Can You Do During A Special Enrollment Period?

The details of your options can change based on the circumstances of each specific SEP. However, you are generally allowed to make one change to your coverage during a declared SEP. For Medicare, this can mean:

• Enrolling in a Medicare Advantage plan.
• Switching from one Medicare Advantage plan to another.
• Dropping Medicare Advantage.
• Switching from one stand-alone prescription drug plan to another.

Your Medicare supplement (medigap) rights are generally not affected by federally declared special enrollment periods.

For under-65 health insurance, an SEP will allow you and other eligible family members to enroll in individual health insurance plans or to switch from one plan to another. If you qualify for the 150% of federal poverty limit SEP, you may be able to make multiple changes to your coverage for as long as you meet the income limits.

How To Take Advantage Of Your Special Enrollment Period

Federally declared special enrollment periods are dynamic situations; the circumstances that cause them tend to “pop up” suddenly and are generally not predictable. Also, given the litany of emergencies that have occurred in the last three years, it can be hard to keep track of the declared SEPs. There are a few ways to explore eligibility, including the health.gov website. Another great way to find out if you’re eligible for an SEP is to chat with a licensed health insurance agent.

If you are eligible, an agent can help you shop for and compare the plans available to you. Once you’ve found a plan that works for you, an agent can help you enroll in it and also provide ongoing service, depending on your needs.

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

Forbes Finance Council is an invitation-only organization for executives in successful accounting, financial planning and wealth management firms. Do I qualify?