Covered California: Special Enrollment Period

Thanks for stopping by today, we’re glad that you’re here. In this blog post we’ll be talking about Covered California’s “Special Enrollment Period.” To keep it simple, this is a period of time when people will be able to enroll in an individual or family health insurance plan outside of open enrollment if certain “life-changing events” are experienced.

Let’s review before we move on: open enrollment for the new Covered California insurance exchange recently finished up. If you’ve been following along, you’ll know that there are now open enrollment periods for individual and family plans both on and off of the new public exchange. In other words, in order to participate in an individual health insurance plan, you’ll now have to enroll during specific times each year. This is called open enrollment.

However, if you experience a qualifying “life-changing event” you may be eligible for a “Special Enrollment Period” in the middle of the year. In other words, yes: you may be able to enroll outside of open enrollment.

Here are some common examples of those qualifying “life-changing events” we described above:

• Marriage or domestic partnership.
• Childbirth, adoption, or placing a child up for adoption or in a foster home.
• Changing your place of permanent residence, therefore gaining access to Covered California plans (this includes moving from another state).
• Losing your health insurance (ie: losing or changing jobs, losing MediCAL coverage, or COBRA coverage expiration).
• Changes in income. If you have an income change in the middle of the year, you may be eligible for more (or less) of a subsidy if you’re currently receiving assistance.
• Becoming a citizen, national, or someone who is residing here legally. This event would only apply to those who were not previously a citizen, national, or legally residing here.
• An “exceptional circumstance.” Covered California will determine on a case-by-case basis whether-or-not someone may be eligible to enroll via an “exceptional circumstance.”
• American Indians or Alaska Natives. You are be eligible to change your plan (or enroll in a new plan) up to once per month even if open enrollment is over.
• Your enrollment was wrong due to the misconduct or misrepresentation of your health insurance company, Covered California, or a Covered California entity (ie: a Certified Enrollment Counselor).

The above listed are examples of common “life-changing events” that might make someone eligible for a “Special Enrollment Period” outside of open enrollment.

Question: How long do I have to enroll if I experience one of these “life-changing events?”

Answer: You have 30 to 60 days (depending on the event). For example, if you lose your job-based coverage, you have 30 days. However, many of the other events give you 60 days. Make sure you know which event occurred, and how much time you have to enroll. 

If you think you’ve experienced a “life-changing event” and are eligible for the “Special Enrollment Period,” please contact us anytime. As a “Certified Insurance Agent,” Policy Advantage Insurance Services is able to help you find plans both on and off of the Covered California exchange (please note: the “Special Enrollment Period” rules do also apply to plans off of the exchange).

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