If you’ve missed the Open Enrollment Period for health insurance, you can still enroll in a private health plan through the ACA Marketplace if you qualify for a Special Enrollment Period (SEP). Special Enrollment Periods allow you to get health coverage outside of the regular enrollment window, especially when certain life events or unexpected circumstances occur.
At Aura Insure, we’re here to help you navigate these special cases and ensure you get the coverage you need when life throws you a curveball. Here’s how you may qualify for an SEP and what steps to take next.
How to Qualify for a Special Enrollment Period
You may qualify for a Special Enrollment Period if:
- You experience a qualifying life event such as having a baby, getting married, moving, or losing minimum essential coverage (like job-based coverage or Medicaid).
- Your household income falls within specific ranges, making you newly eligible for savings.
- You face one of the complex situations listed below.
If you believe you might be eligible, answer a few questions, and explore your coverage options through Aura Insure.
Qualifying Life Events for Special Enrollment Periods
1. Unexpected Life Changes
You may qualify for a Special Enrollment Period if you experience life events such as:
- Getting married or divorced.
- Having or adopting a child.
- Losing your job-based health coverage.
- Moving to a new area with different health plan options.
2. Complex Issues or Unexpected Situations
Sometimes, unexpected events or serious circumstances can prevent you from enrolling during the Open Enrollment Period. In these cases, you may still qualify for an SEP. Examples include:
- Facing a serious medical condition or incapacitation, such as an unexpected hospitalization.
- Experiencing a natural disaster like a hurricane, flood, or earthquake that prevents you from enrolling on time.
If you live in a county eligible for federal disaster assistance (as designated by FEMA), you may qualify for an SEP. You’ll have 60 days from the end of the disaster period to complete your enrollment, and you may request your plan start date to reflect when you would have enrolled if not for the disaster.
3. Enrollment or Plan Information Errors
If you were unable to enroll in a plan due to misinformation, technical errors, or mistakes made by someone working to help you (such as an insurance agent or broker), you may qualify for a Special Enrollment Period. For example:
- Misrepresentation or misconduct by someone assisting you in the enrollment process.
- Technical errors on HealthCare.gov that prevented you from completing your enrollment or led to incorrect plan details being displayed.
Newly Eligible for Savings on an ACA Marketplace Plan
If your income changes or you move, making you newly eligible for savings like premium tax credits, you may qualify for an SEP. For example:
- If you previously lived in a state that didn’t expand Medicaid and your income was too low to qualify for assistance, an increase in income could make you newly eligible for Marketplace savings.
Other Special Enrollment Period Qualifications
Here are other situations that may qualify you for an SEP:
1. Denied Medicaid or CHIP: If you applied for Medicaid or CHIP coverage but were found ineligible after Open Enrollment or an SEP ended, you may qualify for a new SEP to enroll in an ACA plan.
2. Court-Ordered Coverage: Gaining or becoming a dependent due to a court order, such as child support, qualifies you for immediate coverage under an SEP.
3. Domestic Abuse or Spousal Abandonment: Survivors of domestic abuse or spousal abandonment may enroll in their own health plan through an SEP. You can qualify for a premium tax credit and other savings if eligible based on your income.
4. Successful Appeal: If you file an appeal with the ACA Marketplace and win, you may qualify to enroll in or change your health plan as part of your Special Enrollment Period.
What to Do If You Think You Qualify for a Special Enrollment Period
If you think you qualify for an SEP, Aura Insure can help guide you through the process. Contact the ACA Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for initial assistance, or work directly with us for personalized help.
At Aura Insure, we’ll ask for information about your situation to check if you qualify for an SEP, assist you in applying, and help you find the right health plan that suits your needs. Even if you’re already enrolled in a plan, SEPs allow you to switch to a new one in some cases. You may also qualify for an earlier coverage start date, depending on the circumstances.
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Get Help with Special Enrollment Periods at Aura Insure
Life can be unpredictable, and missing Open Enrollment doesn’t mean you’re out of options. At Aura Insure, we’re committed to helping you navigate the health insurance marketplace and ensuring you get the coverage you deserve, even in complex situations.
Contact Aura Insure today to see if you qualify for a Special Enrollment Period and get expert guidance on your health insurance options.
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