Qualifying Life Events
You may be eligible to join a Marketplace ACA health plan with an SEP (Special Enrollment Period) outside of the annual open enrollment period if you have a Qualifying Life Event. Most SEPs are 30 days prior to and/or 60 days after the event date. Coverage begins the 1st of the month following your application but not prior to the event date.
Please note, these are just examples below for illustrative purposes and final review and approval must occur by the Federal Marketplace.
Questions? Call or Text Ken Locke and Associates at 262-536-5155
Loss of Coverage
If you lose qualified, credible coverage you may be eligible for a Special Enrollment Period (SEP).
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Losing existing health coverage, including job-based, individual, and student plans
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Losing eligibility for Medicare, Medicaid, or CHIP
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Turning 26 and losing coverage through a parent’s plan
Changes in Household
If you have a change in your tax household, you may be eligible for a SEP (Special Enrollment Period):
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Changes in household
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Getting married
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Getting divorced and coverage loss occurs
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Having a baby or adopting a child (retroactive coverage may be available to date of birth)
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Death in the family which causes a loss in coverage
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Change in Residence
If your address changes, you may be eligible for an SEP:
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Moving to a different ZIP code or county
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A seasonal worker moving to or from the place they both live and work
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Moving to or from a shelter or other transitional housing
Other QLEs
Less common situations that may generate a SEP would include:
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Annual income below 150% of the FPL
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Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
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Becoming a U.S. citizen
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Leaving incarceration (jail or prison)
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AmeriCorps members starting or ending their service
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Additional events may be available, see https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
