There’s just no getting around it — you have to be pretty special to get health insurance coverage outside of the open enrollment period (which is only six weeks this year, November 1 – December 15). Open enrollment is the annual period of time during which you are able to enroll in a health insurance plan. Typically, this period is at the end of the year, with January 1 of the next year being the first date with new coverage.
So what happens if you lose your health coverage in the middle of the year? Or on January 2? Any time you lose coverage, it may be an opportunity to enroll in coverage OUTSIDE of the open enrollment period. Losing insurance, the birth of a new baby, a marriage, divorce, death, adoption, and a whole list of other situations could constitute a qualifying life event that will grant you a Special Enrollment Period (SEP). The Center on Budget Policies and Priorities created this handy guide of all other different types of SEPs. The fact that it is eight (8) pages long should be an indication to you of how many possible SEPs there are. But there are also details regarding how long you may be eligible for an SEP, what documentation must be submitted to the Health Insurance Marketplace to be fully eligible, and if the SEP is granted through the online application process or only through the Healthcare.gov call center.
Because South Carolina is a non-Medicaid expansion state, one of the most common SEPs that enrollment assisters should encounter is an income change that elevates a person’s income above 138% FPL, or out of the Medicaid coverage gap. It is not necessary for the consumer to have previously applied to the Marketplace and have in hand a copy of the eligibility notification that denies APTC to the consumer.
HOWEVER, Shelli Quenga, director of programs, still strongly encourage enrollment assisters to work with consumers to get that in hand. “The notification that the consumer is too poor for affordable coverage protects the consumer from a pro-rated penalty for being uninsured,” she said. For many consumers, there’s simply no way to guarantee that they will not get a better paying job during the year, find more part-time work, or experience another life change that would make them eligible for APTC and then affordable coverage. “Going through the application process and getting the notification is the best way to protect the consumer from any unnecessary tax burden,” Quenga said.
If we lost you at the first paragraph, do not worry. Certified insurance navigators are ready to answer your questions about your options for coverage in South Carolina at the signupSC scheduling center, 888-998-4646. Our scheduling center navigators can answer your questions and make an appointment for you to meet with a certified enrollment assister in your community. You can also schedule an appointment by clicking here.