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Health Insurance Special Enrollment Period

By April 4, 2019 No Comments

Have You Recently

Lost Health

Insurance Through:

  • work?
  • Oregon Health Plan (OHP)?
  • or any other health insurance provider?
  • Good News!

    Oregonians who receive federal subsidies get an average of $349 per month to help cover the cost of private insurance purchased through the Marketplace.

    What is Special Enrollment Period?

    Special Enrollment Period (SEP) – is a time outside the yearly Open Enrollment Period when you can sign up for health insurance through the Health Insurance Marketplace. People with Qualifying Life Events (QLE) can take advantage of the Special Enrollment Period.

    How long do you need to enroll in a new plan? If you qualify for Special Enrollment Period (SEP), you have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period (Nov 1 to Dec 15) to apply.

    Eligible people can take advantage of a health insurance qualifying life event to modify or elect for new health care coverage. It is like an open enrollment for the whole family.

    How to qualify for Health Insurance Special Enrollment Period?

    If you or anyone in your household in the past 60 days have these types of qualifying life event:

    Loss of health insurance coverage
    If you lose your:

    • job-based coverage
    • COBRA coverage
    • individual health coverage for a plan or policy you bought yourself
    • eligibility for Medicaid / OHP or CHIP
    • eligibility for Medicare
    • coverage through a family member

    oregon-special-enrollment-periodChanges in household size

    • Got married. Pick a plan by the last day of the month so your coverage can start the first day of the next month.
    • Had a baby, adopted a child, or placed a child for foster care. Hence, your coverage can start the day of the event — even if you enroll on a health plan 60 days after.
    • 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.
    • Death. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

    Changes in residence

    • Moving to a new home in a new ZIP code or county
    • Moving to the U.S. from a foreign country or United States territory
    • A student moving to or from the place they attend school
    • A seasonal worker moving to or from the place they both live and work
    • Moving to or from shelter or other transitional housing

    More qualifying changes

    • Changes that make you no longer eligible for Oregon Health Plan (Medicaid) or the Children’s Health Insurance Program (CHIP)
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
    • Leaving incarceration
    • AmeriCorps VISTA members starting or ending their service

    Know if you qualify for tax credits to help pay for your insurance premium.

    To qualify for health insurance plan through the Health Insurance Marketplace, your income must be above the Oregon Health Plan eligibility limits in 2019. Please see chart below.

    2019-income-eligibility-premium-tax

    If you’re single, your income is over $1,396 per month and have a qualifying event, you may be eligible for tax credit to shop for the most affordable health insurance plan through the Health Insurance Marketplace.

    However, if your income is below $1,396 per month, you can enroll in Oregon Health Plan which is a FREE health coverage provided by the state of Oregon.

    Please NOTE: You can enroll in Oregon Health Plan and the Children’s Health Insurance Plan (CHIP) any time of year, whether you qualify for a Special Enrollment Period or not.

    Documents needed in signing up during SEP

    Health Insurance plans in Oregon or the Health Insurance Marketplace will require documents or proofs stating that you recently lost coverage or eligible to enroll during Special Enrollment Period (SEP). Here are some documents needed:

    Documents for Loss of Health Insurance Coverage
    These documents must show that you either lost health insurance coverage in the past 60 days or will be losing that coverage in the next 60 days. These should have your name and the date of coverage lost.

      • A letter from your insurance company showing the termination of your health insurance coverage.
      • A loss of health insurance coverage letter from an employer.
      • A notification of being denied for Oregon Health Plan. Moreover, a letter stating that your Oregon Health Plan coverage ended or will end is also acceptable.

    Documents for Change in Primary Residence
    If you qualify for SEP because of moving to a different state, then you need to send documents that confirm both of these:

      • You moved in the last 60 days.
        – government correspondence, bills or financial statement, mortgage or rental documents, homeowner’s insurance, letter from an insurance company
      • You had health coverage for at least one day during the 60 days before your move.
        – correspondence from your insurance company, employer, or health coverage provider

    Documents for Change in Household Size
    Since this Qualifying Life Event (QLE) involves either marriage, adoption, birth, divorce or death; legal or government-issued documents tied to these events are typically requested.

    Special Enrollment Plan Effective Dates:

    When you enroll on Health Insurance Marketplace plan, your health plan effective date will differ depending on the qualifying event and when you submit your application.  Please see details below:

    Qualifying EventPlan Effective Date
    Lost coverage

    (either from Employer, Cobra or OHP)

    1st day of the month after enrollment application
    Changes in Household

    (Got married, Had baby, Got divorced or Death)

    1st day of the month after enrollment application
    Changes in ResidenceEnrollment application received 1-15th: first day of the following month,

    Enrollment application received 16-31st, first day of second following month

    Others

    (Release from incarceration / End of military service)

    Enrollment application received 1-15th: first day of the following month,

    Enrollment application received 16-31st, first day of second following month

    Have you missed Special Enrollment Period or don’t have qualifying event?

    You may want to look at short-term health insurance. Short-term insurance doesn’t cover pre-existing conditions and may have limited benefits compared to Health Insurance Marketplace insurance plans but it’s a flexible health insurance coverage solution when you need coverage for a period of transition in your life. It can fill that gap in coverage until you can choose a longer term health plan solution.

    Or you may opt for supplemental insurance that will provide you with cash benefits to cover unexpected expenses for illness or injury.  Having supplemental insurance will still give you protection – better than not having coverage at all.

    Get free assistance.

    If you have any questions about your health plan or want to know if you qualify to enroll for 2019 health insurance, give us a call at 503-998-6169 – Health Plans In Oregon. We’re local, independent and licensed agent who has been helping Oregonians since 2006.

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