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How to update your health coverage before open enrollment
Something big happening in your life like having a baby or moving to a new state? You may be eligible to update your plan during a special enrollment period. Here’s how it works.
You signed up for your insurance last fall when the only person you needed to care for was yourself. Now you’re about to get married, and your future spouse doesn’t have great coverage. Do you have to wait until next year before you can add them to your plan?
Nope. Getting married is one of the life events that makes you eligible for an insurance update no matter the time of year.1 The official term is “special enrollment period (SEP).”
If your life takes a new turn, here’s what to know about updating your coverage so that it fits your needs and budget.
What is an SEP and how does it work?
Life happens when it happens. And if you’re nowhere near your health insurance company’s open enrollment period, you don’t need to wait. That’s when you can take advantage of an SEP.
So what types of events can get you an SEP? Here are some examples:
- Turning 26 (you’re no longer eligible to be on your parents’ insurance policy)
- Becoming a U.S. citizen
- Getting married or divorced
- Getting out of jail or prison
- Having a baby or adopting a child
- Losing your health insurance (you leave a job, retire or move out of your coverage area)
- Moving to a different area or county
- The death of a spouse
- Turning 65 or becoming eligible for Medicare
These aren’t the only examples of events that can get you an SEP. For a complete list, go to healthcare.gov. You can also call your health insurance provider or talk to your employer to get the process started.
SEPs typically give you 60 days from the event to sign up for a new health plan. You might need to submit proof of your life change. That could include a birth certificate, mortgage or lease agreement or marriage license.
Tip: Before you change plans, don’t forget to make sure that your doctors are part of your new plan. If you need to find a new one, we can help.
How an SEP can help you join Medicaid or CHIP
Let's say you or your spouse loses a job. Your yearly income may go down a lot. And that could make it hard to afford certain things. Or maybe you have a job, but you don’t earn enough to pay for health insurance on top of other expenses.
Here’s some good news: If you lose your job or your yearly income dips below a certain amount, you can get an SEP. Depending on your income, you may be eligible to join Medicaid or the Children’s Health Insurance Program (CHIP), free or low-cost health plans for lower-income people.
You can qualify for these plans if you earn less than 150% of the federal poverty level (FPL). In 2022, that’s $20,385 per year for a single individual or $34,545 for a family of three. The rules can be different based on what state you live in. For example, the FPL is higher in Alaska and Hawaii. You may also have to provide proof of your income level before joining.
If your income is in range, you can get an SEP that allows you to join Medicaid or CHIP at any time. You can apply for Medicaid and CHIP through healthcare.gov.2
When to consider short-term insurance
Sometimes life is so busy that you miss your enrollment deadlines. If that happens, you can explore short-term insurance policies. These plans are available from private companies. They don’t have open enrollment windows, so you can sign up for them at any time.
They tend to be less expensive than traditional plans. But they also don’t have the same required benefits. They generally don’t cover medical conditions you already have. But they do cover some preventive health care and care in the hospital if you need it.3
Know your plan’s enrollment periods
Every health plan has a certain time of year when everyone can sign up or re-enroll. It’s often called open enrollment. Here are the dates for different types of insurance:
- Affordable Care Act plans: Begin November 1
- Medicare: October 15 to December 7
- Medicare Advantage: January 1 through March 31
- Employer-based plans: They vary but often take place in the fall.
If your life path happens to align with these dates, you may not need an SEP. But if it doesn’t, remember that you have options.
- HealthCare.gov. Enroll in or change 2022 plans — only with a Special Enrollment Period. Accessed June 6, 2022.
- Healthcare.gov. Medicaid & CHIP. Accessed June 5, 2022.
- CMS.gov. Short-term, limited-duration insurance final rule. August 1, 2018. Accessed June 8, 2022.
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