Know the Difference between Open Enrollment and Special Enrollment Period
Special Enrollment Period
Special Enrollment Period is a time when an individual can enroll in a health insurance plan outside the annual Open Enrollment Period.
An individual must experience a qualifying life event and provide proof of eligibility in order to qualify. During the Special Enrollment Period, individuals may enroll in the Affordable Care Act (ACA) health insurance On- or Off- the Virginia's Insurance Marketplace or change from one Qualified Health Plan to another.
Individuals and/or their dependents have 60 days to enroll for health coverage after experiencing a qualifying life event. If you are a Virginian who loses Medicaid coverage, you have 90 days to enroll in a qualified health plan.
Certain life events like getting married, having a baby, or losing other health coverage enable you to enroll outside the Open Enrollment Period.
- Job-based plans may have different Open Enrollment Periods. Check with your employer.
- You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.
How Soon Can Coverage Start During a Special Enrollment Period?
New for 2024, most qualifying life events allow you to enroll and begin coverage the firs day of the next month. This works the same as it does during the Open Enrollment Period. For example:
- If you enroll on May 10, your coverage starts June 1.
- If you on enroll May 17, your coverage starts July 1.
This works the same as it does during the Open Enrollment Period. However, there are a few exceptions which allow same-day effective coverage to begin:
- Birth of child
- Adoption of child
What Are Examples of Qualifying Life Events?
Qualifying life events are significant changes in your life that enable you to enroll in a health insurance plan outside of the Open Enrollment Period. These qualifying life events may cause you to lose your health coverage or have a change in family status or residency.
Losing Your Health Coverage
- Losing coverage because your current health insurance carrier left the service area
- Losing job-based coverage for any reason including resigning, getting laid off, or getting fired
- Expiring COBRA coverage
- Losing coverage under your parents’ plan at age 26
- Getting divorced or legally separated (resulting in loss of coverage)
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
Note: Losing coverage that doesn’t qualify as minimum essential coverage doesn’t qualify you for a Special Enrollment Period. Learn more at HealthCare.gov.
Change in Your Household Size
- Getting married
- Having a baby
- Adopting a child or placing a child for adoption or foster care
- Death of family member (causing you to lose eligibility in your current plan)
Change in Circumstance
- Permanently moving outside your plan’s coverage area
- Gaining or losing income (affecting eligibility for premium tax credits or cost-sharing reductions)
Change in Status
- Getting released from jail or prison
- Gaining citizenship or lawful presence in the U.S.
For more information on required documentation, please visit HealthCare.gov.
How Long Does a Special Enrollment Period Last?
A Special Enrollment Period is triggered by a qualifying life event and typically lasts for 60 days. However, the Special Enrollment Period may vary based on the type of qualifying life event.
| Qualifying Life Event | Special Enrollment Period (SEP) |
| Qualifying Life EventGetting Married | Special Enrollment Period (SEP)Up to 60 days after the event. |
| Qualifying Life EventHaving a baby, adopting or placing a child for adoption | Special Enrollment Period (SEP)Up to 60 days after the event. |
| Qualifying Life EventLosing your health coverage | Special Enrollment Period (SEP)Up to 60 days before and up to 60 days after the event. |
| Qualifying Life EventMoving outside your plan's coverage | Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment. |
| Qualifying Life EventGaining U.S. citizenship | Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment. |
| Qualifying Life EventChange in income or household status that affects eligibility for premium tax credits or cost-sharing reductions | Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment. |
| Qualifying Life EventLosing Medicaid coverage | Special Enrollment Period (SEP)Up to 90 days after the event. |
| Qualifying Life EventRelease from prison or jail | Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment. |
| Qualifying Life EventHardship Exemption* | Special Enrollment Period (SEP)Up to 60 days after the event. |
What is a Hardship Exemption?
*A hardship exemption is an exceptional circumstance, and it triggers a 60-day Special Enrollment Period. Examples of exceptional circumstances are unexpected hospitalizations, natural disasters, or temporary cognitive disability. Other hardships may include enrollment errors created by the Virginia's Insurance Marketplace, your broker or by your insurance carrier. For more information, please visit Virginia's Insurance Marketplace.
5 Simple Steps for Open Enrollment
Open Enrollment Period
Open Enrollment Period is the yearly timeframe when individuals can enroll in a health insurance plan. Open Enrollment Period typically runs from November 1 - December 15. You do not need a qualifying life event to enroll in a health insurance plan during the Open Enrollment Period.
Your Open Enrollment Checklist
1. Visit our Health Insurance 101 video library to help you understand terminology and how deductibles, copayments and coinsurance work.
2. Find out if your employer will offer coverage or if you need to purchase an individual health insurance plan.
3. If you are under the age of 26 you may be able to stay on a parent’s health plan until your 26th birthday. Speak with your parents about your options.
4. Gather information on your household income. You may qualify for a subsidy to reduce your insurance costs or you may qualify for another government program.
5. Set your budget. Larger premiums usually mean lower out-of-pocket costs for prescription drugs, office visits, and procedures, and vice versa. How much you can afford for a premium and out-of-pocket expenses are both important considerations when selecting a health plan for you and your family.
Looking for Coverage?
To learn about your plan, talk to one of our Sentara Individual & Family Health Plan Advisors at 1-844-206-3208