You often hear that you may be eligible for a SEP. (Special Enrollment Period)
To some being able to take advantage of a SEP is a godsend during hard times or otherwise provides flexibility during change.
In plain English, the definition of a Special Enrollment is an exception to set rules preventing plan participants from joining a health plan at any time.
Most health plans have specific enrollment periods where they allow subscribers to join.
To join a health plan outside of the standard enrollment periods some plans require that you have a Qualifying Life Event (QLE) or other qualifying criteria.
Most people don’t know what this means to them so we have consolidated the most common ways in which one may be eligible for a SEP.
If you are a Medicare Eligible Enrollee Check your Enrollment Here
(Please Visit Medicare.Gov for Up to date information on when you can join or change plans)
- You moved to a new address that is outside of your plan’s service area.
- You moved to a new address that is still in your plan’s service area but have new plan options.
- You are an Expat and have moved back to the U.S. after living abroad.
- You moved into, currently live in, or moved out of an intuitional setting. (Skilled Nursing or Long-Term Care Hospital)
- You were recently released from jail and are eligible for Medicare.
- You lost your eligibility for Medicaid.
- You left your employer or union provided coverage including COBRA.
- You enrolled in other drug coverage specifically TRICARE or VA Coverage.
- You enrolled in a PACE (Program of All Inclusive Care for the Elderly) Plan
- Your Medicare plan has a falling out with Medicare (Your plan is sanctioned or Medicare terminates your plans contract)
- Your plan fails to renew its contract with Medicare.
- You become eligible for both Medicare and Medicaid.
- You qualify for extra help for Medicare prescription drug coverage.
- You are enrolled in a State drug assistance program (State Pharmaceutical Assistance Program SPAP) or loose SPAP eligibility due to a change in circumstances.
- You dropped a Medigap policy the first time you joined a Medicare advantage plan.
- You have a severe or disabling condition and there is a Medicare Chronic Care Special Needs Plan (C-SNP) that serves subscribers with your conditions.
- You lose eligibility of to participate in a C-SNP because you no longer have the condition which made you eligible for the C-SNP.
- You joined or failed to join a plan due to an error by a federal employee.
- You were not properly informed that your other private drug coverage wasn’t as good as Medicare drug coverage.
- You were not properly informed that you were losing private drug coverage that was as good as Medicare drug coverage.
- You are interested in a 5-Star Medicare Advantage plan available in your area
Healthcare Exchange/ACA (AHCT) Enrollee
Qualifying Life Events Include
- Loss of coverage due to Job Loss or Change
- Pregnancy, Birth, Adoption, or Foster Care
- Moving Into CT
- Divorce or Legal Separation
- Involuntary Loss of Coverage
Thanks to the ACA if you find yourself having any of these life events you may start an application for coverage at AHCT.
If you already have an AHCT account you can simply sign-in and update your information.
Once you start your application AHCT may request proof of your Qualifying Life Event.
You MUST provide proof within 30 days of a request from AHCT in order to take advantage of the SEP if you delay you could lose out on premium savings.
Once AHCT confirms your Qualifying Life Event they may request additional documentation from you such as proof of income, citizenship, or residency.
When verified you may be able to get financial help, or access to Medicaid (CHIP) for those who qualify.
We can help you with your enrollment, contact us today to get more information.