Special Enrollment Period (SEP): Top 5 Ways to Qualify in 2024
If you missed open enrollment from November 1st - January 15th and currently need health insurance coverage due to certain life events or income changes, you may qualify for the Special Enrollment Period. This period from January 16th - October 31st allows individuals a chance to apply for or change their current plan from the Health Insurance Marketplace at any time during the year. In this post, we will go over the most common ways people can qualify for this and give real examples so you can determine if this applies to you.
If your situation seems complicated or not listed please feel free to message us so we can let you know what your options are. We are licensed and trained to help.
Table of Contents:
Change in Primary Place of Living
Change in Household Size
Change in Income
Loss of Health Insurance
Change in Eligibility for Marketplace Coverage
Change in Primary Place of Living
This one is simple, if you or anyone in your household has moved recently, you can qualify for the special enrollment period. Once you move, you can gain access to new Marketplace Health Plans and pricing may change, opening the door for you to apply. Do any of these situations apply to you?
Moved to a new zip code or county
Moved to the U.S. from a foreign country or U.S. territory
Moved to or from where you attend school (if you are a student)
Moved to or from where you both live and work
Moved to or from where you live in a shelter or other transitional housing
Most of the time you can only qualify for a Special Enrollment Period if you had qualifying health coverage for at least one day in the 60 days before your move. This does not apply if you were living in a foreign country or U.S. territory for at least one day in the 60 days before the move.
2. Change in Household Size
If you or anyone in your household got married, had a baby/adopted a child, or became a dependent due to a child to support you can qualify to apply for Health Insurance through the Marketplace during the special enrollment period. If you became or gained a dependent through marriage, one spouse must have also had health coverage for at least one day in the 60 days before the marriage.
Let’s see two examples below of people who can get insurance via the SEP.
Jane recently had a baby girl born on July 1st. Jane wants to add her baby to her current medical plan. Jane has 60 days from the time of birth (or adoption) to contact the insurance company to add the baby onto the plan. Jane may have new coverage options with better savings with the addition of the newborn.
Tom just got married in August and wants to add his spouse to his current health insurance plan on the marketplace. Even though it is outside open enrollment dates, he can apply for coverage for his spouse in August because he qualifies for the special enrollment period.
3. Change in Income
Change in income can result in you being able to apply for coverage through SEP. If you are eligible for the advanced premium tax credit AND have an estimated household income at or below 150% of the federal poverty level, you can apply for health coverage for you and your family members during special enrollment. The federal poverty level changes every year and is based on your household income so you can see where you are at.
If you have a household size of 1 and you are estimated to make between $15,060 and $22,590 in 2024 then you qualify for this special enrollment period.
If you have a household size of 4 and you are estimated to make a household income between $31,200 and $46,800 in 2024 then you also qualify for this SEP.
Unsure if you qualify? Check with us and we will send you a response based on your household income/size.
4. Loss of Health Coverage
If you or anyone in your household has lost qualifying health coverage then you can apply during the Special Enrollment Period. Some examples would be:
You left a job that you had health insurance through
Medicaid or Children’s Health Insurance Program (CHIP) coverage ended
Coverage under your parent’s health plan was ended because you turned 26
This means you don’t have to worry about waiting til the end of the year to apply for coverage if you lost it during the year through a valid way as defined by healthcare.gov
5. Change in Eligibility for Marketplace Coverage
Another great way to get enrolled outside of open enrollment is if you had a life event that now changes your eligiblity for coverage. Here are some examples:
You became a citizen, national, or lawfully present individual
You were released from incarceration
You report a change that makes you newly eligible for help paying for coverage
Hope this was helpful in showing you some ways you can apply for health insurance coverage through the Marketplace during the Special Enrollment Period which opens the door for you to apply at almost anytime during the year. Mutual Wealth Insurance is committed to sharing insurance resources and helping clarify information so you and your family can make well-informed decisions.
