WPS Health Insurance Blog

Special Enrollment Periods under tighter enforcement

Posted by Ryan Kanable

Feb 10, 2016 3:24:34 PM

sep.jpgOpen Enrollment for 2016 is now over. If you didn’t sign up for a health plan during open enrollment, you may be out of luck until the next Open Enrollment begins in November. One way that you may still be able to get coverage is through a Special Enrollment Period (SEP).

SEPs allow you to get health insurance coverage outside of Open Enrollment, but the circumstances under which you may qualify for an SEP are getting tightened up. Why? Because some folks are trying to game the system.

The Affordable Care Act created limited windows for people to enroll as an incentive to sign up for both the sick, who need coverage right away, and the healthy, who may need it in the future. The biggest window is the annual Open Enrollment Period, which runs from the beginning of November until the end of January. Most people sign up then—more than 12.7 million signed up during the one that just ended—but there are some who wait until they’re sick.

When people go without health insurance and then sign up through an SEP only when they get sick or need health care, it drives health insurance costs up. It also means that people who join a health plan through an SEP are more likely to be sick than the average person. To help curtail this issue, the Health Insurance Marketplace is making changes to some of the circumstances under which an individual may qualify for an SEP. Here are some of the changes from the Health Insurance Marketplace:

  • The SEP for tax season has been eliminated.
  • Six SEPs for limited circumstances were eliminated.
  • Clarified that an SEP for a permanent move cannot be used for a short-term or temporary move.
  • The Health Insurance Marketplace will also conduct assessments of plan selections that are made through certain SEPs to evaluate whether consumers properly accessed coverage.

SEPs are intended to help people with major life changes, such as moving, having a child, or getting married. They also can allow you to sign up if you had trouble getting your application submitted before the end of Open Enrollment. You can see a list of situations here. If you have a change in your life and lose your coverage, take a look at SEPs and see if you’re able to regain health insurance for yourself or your family.

For more information about qualifying for an SEP, talk to your local agent or call the Marketplace at 1-800-318-2596.


Topics: health insurance