Open enrollment lasts for a finite period each year.
If you’ve missed open enrollment, you’ll need to see if you’ve had any Qualifying Life Events that would entitle you to a Special Enrollment Period.
There are four types of Qualifying Life Events: loss of health coverage, changes in household, changes in residence, or other qualifying life events.
Have you ever heard the saying “luck favors the prepared?” Surprisingly, it didn’t originate with a character in The Incredibles. The original quote is actually attributed to Louis Pasteur, the famous French chemist and microbiologist who became well known for his advances in vaccines and fermentation and for discovering the process of pasteurization. (Milk drinkers of the world, unite!) His full quote was actually, “Fortune favors the prepared mind.”1 Same idea. We think that’s a really powerful notion, especially in the context of our article topic: what to do if you’ve missed open enrollment.
In keeping with the theme of that quote, it’s important to remember to be prepared once benefit enrollment time rolls around. Thankfully it tends to occur around the same time every year. But, as so often happens in life, things can get in the way and that window can be missed. The first thing you should know should that happen to you is: don’t panic! Missing the open enrollment periods at work or for the healthcare exchange doesn’t necessarily mean you won’t have access to health insurance, or other benefits for that matter.
How is this possible, you ask? It’s time to get familiar with (and become really thankful for) Special Enrollment Periods (SEP) and Qualifying Life Events (QLE).
What is a Special Enrollment Period?
Open enrollment isn’t the only time to enroll in healthcare or other benefits like life insurance and disability insurance. To add or change benefits outside of open enrollment, an individual can qualify for a special enrollment period, which can last 30 (employer-provided benefits for employees)2 or 60 days (individual enrollment in the ACA marketplace) from the date of a qualifying life event.3 If you missed your initial enrollment period for Medicare because you already had group health plan coverage based on current employment, you can enroll in Part A and/or Part B while still covered by the group health plan or during the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.4
What qualifies as a life event?
A qualifying life event (QLE) is a change in your situation that can make you eligible for a special enrollment period. Depending on which type of healthcare plan you have, there are different types of qualifying life events that can trigger an SEP, like loss of health coverage, changes in household, changes in residence, or other qualifying life events.5 You can find more specific information about each below. Be sure to check with your healthcare plan for the specifics for your plan.
Loss of health coverage
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days3 (or more than 60 days ago but since January 1, 2020) or expects to lose coverage in the next 60 days (30 days for employer-based plans — be sure to check with your personal healthcare plan provider for the specifics for your plan).2
Changes in household
There are several types of life events that fall under “changes in household.” This isn’t a complete list but should give you a good idea of the range of events covered:5
Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan at the end of the allowed timeframe.
Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
Passed away. You’ll qualify for a Special Enrollment Period if someone on your plan dies and that causes you to lose your current health plan.
Changes in residence
You may qualify for a Special Enrollment Period if you move to:5
A new home in a new ZIP code or county
The U.S. from a foreign country or United States territory
Or move to or from:
The place you attend school (if you're a student)
The place you both live and work (if you're a seasonal worker)
A shelter or other transitional housing
Other qualifying life events5
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becoming a U.S. citizen
Leaving incarceration
Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member
Medicaid and the Children’s Health Insurance Program (CHIP)6
Medicaid and CHIP enrollment is year-round, so if you or your children are eligible, you can enroll any time. Enrollment eligibility for these health insurance plans is based on income.
Medicaid and CHIP had 89,444,160 total enrollees as of June 2022
40,752,398 individuals were enrolled in CHIP or were children enrolled in Medicaid
Now that we’ve given you all of this wonderful background info, we thought we’d help you put it to the test — literally. But there’s no need to worry — this isn’t going on your permanent record or anything. It’s just a fun way to help you solidify what you’ve learned about open enrollment. Ready? Let’s do this!
Transamerica Resources, Inc. is an Aegon company and is affiliated with various companies which include, but are not limited to, insurance companies and broker dealers. Transamerica Resources, Inc. does not offer insurance products or securities. The information provided is for educational purposes only and should not be construed as insurance, securities, ERISA, tax, investment, legal, medical or financial advice or guidance. Please consult your personal independent professionals for answers to your specific questions.
