Special Enrollment Period (SEP)

Life events change your health insurance needs – Do you qualify for a Special Enrollment Period?

Do I Qualify for an ACA Special Enrollment Period (SEP)?

Life has ups and downs. When a life changing event impacts your health insurance, you may qualify for an Affordable Care Act special enrollment period (SEP). An SEP is a short window outside of open enrollment when you can enroll in an ACA health plan due to a life event. Your new coverage usually starts the first of the month after you enroll.

Qualified Life Changing Events

The number of people in your household changed

  • You got married.
  • You had a baby, adopted a child, or placed a child for foster care.
  • You got divorced or legally separated and lost health insurance. Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Someone on your ACA health plan died and you are no longer eligible for your current health plan.

You’re moving

  • You’re moving to a new home in a new ZIP code or county
  • You’re moving to the U.S. from a foreign country or United States territory
  • You’re a student moving to or from the place you attend school
  • You’re a seasonal worker moving to or from the place you both live and work
  • Your’e moving to or from a shelter or other transitional housing

You lost your health insurance

  • You or someone in your household lost has job-based coverage
  • You or someone in your household retired and no longer has job-based coverage
  • Your employer will no longer help pay for the cost of health coverage
  • You lost individual health coverage for a plan or policy you bought yourself
  • You are no longer eligible for Medicaid or CHIP
  • You are no longer eligible for Medicare
  • You are no longer covered on a family member’s plan
  • You or anyone in your household newly gained or will soon gain access to an individual coverage health reimbursement arrangement (HRA), a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA), or an individual coverage health reimbursement arrangement ICHRA)

Other qualifying life circumstances

  • You are now or soon will be a member of a federally recognized tribe or will get status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • You became a U.S. citizen
  • You were or soon will be leaving incarceration
  • You are starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

Your Income is Below 150% of the Federal Poverty Line (FPL)

If your household income is below 150% of the federal poverty level (FPL), you are eligible to enroll in an ACA health plan any time during the year. This is considered a life changing event that qualifies you for a special enrollment period (SEP). You may even qualify for a $0 premium ACA health plan.

The following table shows the FPL for 2023 marketplace coverage based on the number of people in your household. If at any time during the year your income dips below 150% for your entire household, you qualify for a special enrollment period.

Table. Federal Poverty Level Chart for the 2023 ACA Coverage Year

Federal Poverty Guidelines for ACA Coverage Year 2023

If you aren't sure if you qualify for a SEP, we can help you figure it out. Please Call: 888.995.1674

Do I Qualify for Medicare Special Enrollment Period (SEP)?

Because life changes, you can make changes to Medicare Advantage and Medicare Part D (prescription drug) coverage, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

Qualified Life Changing Events

You Moved

You moved outside of your plan’s service area

  • You can switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.
    • If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

You moved to a new address that’s still in your plan area, but you have new plan options in that new location.

  • You can switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.
    • If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

You moved back to the US after living outside the country.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • Your chance to join lasts for 2 full months after the month you move back to the U.S.

You moved into, currently live in, or just moved out of an institution, like a skilled nursing facility or long-term care hospital. Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you leave the institution.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare.
  • Drop your Medicare prescription drug coverage.

You were released from jail and you kept paying for your Part A and Part B coverage while you were in jail, you have 2 full calendar months after you’re released from jail to join a plan. You have to sign up for Medicare before you can join a plan.

    • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.

You Lost Your Current Coverage

You are no longer eligible for Medicaid. You have 3 full months from either the date you’re no longer eligible or notified, whichever is later to:

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare.
  • Drop your Medicare prescription drug coverage.

You left coverage from your employer or union, including COBRA coverage.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • Your chance to join lasts for 2 full months after the month your coverage ends.

You involuntarily lost other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or your other coverage changed and is no longer creditable.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • Your chance to join lasts 2 full months after the month you lose your creditable coverage or you’re notified that your current coverage is no longer creditable, whichever is later.

You had drug coverage through a Medicare Cost Plan and you left that plan.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • Your chance to join lasts 2 full months after the month you lose your creditable coverage or you’re notified that your current coverage is no longer creditable, whichever is later.

You dropped your coverage in a Program of All-Inclusive Care for the Elderly (PACE) plan.

  • Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
    • Your chance to join lasts for 2 full months after the month you drop your Program Of All-Inclusive Care For The Elderly (Pace) plan.

Your Plan Changes its Contract with Medicare

Medicare takes an official action, called a sanction, because of a problem with the plan that affects you.

  • Switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
    • Your chance to switch is determined by Medicare on a case-by-case basis.

Medicare ends your plan’s contract.

  • Switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
    • Your chance to switch starts 2 months before and ends 1 full month after the contract ends.

Your Medicare Advantage Plan, Medicare Part D Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed.

  • Switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
    • You can make changes between December 8–the last day in February.

Other Special Circumstances

You are eligible for both Medicare and Medicaid.

  • Join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage during each of these periods:
    • January – March
    • April – June
    • July – September

You qualify for Extra Help paying for Medicare prescription drug coverage.

  • Join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage during each of these periods:
    • January – March
    • April – June
    • July – September

You are enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.

  • Join either a Medicare drug plan or a Medicare Advantage Plan with prescription drug coverage.

You dropped a Medigap policy the first time you joined a Medicare Advantage Plan.

  • Drop your Medicare Advantage Plan and enroll in Original Medicare. You’ll have special rights to buy a Medigap Policy.

You have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition.

  • Join a Medicare Chronic Care Special Needs Plan (SNP).

You are enrolled in a Special Needs Plan (SNP) and no longer have a condition that qualifies as a special need provided by the plan.

  • Switch from a Special Needs Plan (SNP) to a Medicare Advantage Plan or Medicare Prescription Drug Plan starting from the time you lose your special needs status, up to 3 months after your SNP’s grace period ends.

You joined a plan or chose not to join a plan due to an error by a federal employee.

  • Your chance to change coverage lasts for 2 full months after the month you get a notice of the error from Medicare. You can:
    • Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
    • Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
    • Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare.
    • Drop your Medicare prescription drug coverage.

You weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage).

  • Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
    • Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare or your plan.

Let our Medicare experts see if you qualify for a Medicare Special Enrollment Period.

Call 888.995.1674

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