by Zach Stone, Strategic Engagement Fellow

Be in the Know

During the last open enrollment period, over 141,000 Coloradans enrolled in health care coverage through Colorado’s health insurance marketplace, Connect for Health Colorado. The next open enrollment period begins on November 1st, 2015, but some consumers will be eligible to sign up before then!

If a consumer has a life-changing event, he or she may qualify for a Special Enrollment Period (SEP). An SEP is a period of time outside the regular open enrollment period when an individual and their family have a right to sign up for health insurance. SEPs can be used to newly enroll in the marketplace, or to switch to a different plan. Consumers are typically allotted 60 days following certain qualifying life change events to sign up for an SEP.

Life-changing events that qualify previously enrolled consumers for a Special Enrollment Period include:

  • Turning 26 and losing coverage under parent’s plan
  • Losing eligibility for Medicaid or CHP+
  • Losing adequate health insurance coverage (known as minimum essential coverage)
  • A change in income that affects a consumer’s eligibility for financial assistance
  • Employer-sponsored coverage becomes unaffordable

Life-changing events that qualify all consumers—previously enrolled or not—for an SEP include:

  • Moving  (if moving to a new rating area)
  • Marriage or divorce
  • The birth or adoption of a child
  • Gaining citizenship
  • Leaving incarceration

Special Enrollment Periods typically begin at the date of the life-changing event, giving the consumer 60 days to sign up for health coverage. However, in certain cases, SEPs can start earlier. For example, if a consumer knows he is going to lose employer-sponsored coverage, he can sign up for a new health plan up to 60 days prior to the loss of coverage. Similarly, consumers losing Medicaid eligibility can qualify for an SEP prior to the end of their Medicaid coverage. By proactively utilizing SEP’s, consumers set to lose their coverage can avoid a gap in coverage and maintain continuity of coverage and care.

Individuals who gain coverage during an SEP are still eligible for financial assistance when buying a plan through Colorado’s health-insurance marketplace, Connect For Health Colorado. If you think you may qualify for an SEP, visit Connect For Health’s website or call in at 855-752-6479.

The recent Supreme Court ruling on marriage equality also ties into SEPs, as newly married Americans can now qualify for an SEP in every state! Further, all legally married couples that file as such can receive financial assistance on their health insurance as a married couple.

Where to Grow

It’s critical that consumers are aware of the life-changing events that could qualify them for a Special Enrollment Period. SEPs empower consumers, often providing them with an opportunity to get covered when they need it the most.

Access to SEPs, however, can still be improved. SEPs are designed to make coverage accessible to consumers who have undergone a substantial change in their life. Whether the event is an individual gaining citizenship, a couple getting married or a person moving into a new area, significant life transitions warrant an individual the opportunity to get covered.

However, one event in particular stands out in its failure to qualify a consumer for an SEP: pregnancy. While having a child is a qualified life change event, this SEP only comes into effect after the child is born. The lack of an SEP for pregnancy can prove tremendously problematic for pregnant women who are uninsured.

If an uninsured woman, who does not qualify for Medicaid or CHP+, discovers that she is pregnant outside of open enrollment, she likely will have no way to access coverage. Roughly half of pregnancies in the United States are unplanned. If a woman isn’t planning on becoming pregnant, it is understandable that she may have not adequately prepared by signing up for health insurance during open enrollment.

Without access to health insurance, both the finances and health of pregnant women are put at risk. Financially, maternity care and delivery can be overwhelming, costing anywhere from $10,000 to $20,000 when there are no complications. This financial burden can ultimately lead to a health risk, as uninsured pregnant women are much more likely to forego or delay prenatal care because they can’t afford it.  Without access to maternity care, the health of pregnant women is put in serious jeopardy, as uninsured pregnant women are 31 percent more likely to experience an adverse health outcome after birth

It is clear that significant life-changing events warrant’s individual the opportunity to get covered. Special Enrollment Periods provide a crucial service to consumers, giving them the opportunity to get care when they may need it most. By adding pregnancy to the list of qualifying life events, we can ensure that pregnant women get the care they need, when they need it.

Check out our factsheet for more information on Special Enrollment Periods:

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