Individual & Family Special Enrollment Periods
You may be able to get health insurance coverage in the Individual & Family marketplace outside of the annual open enrollment period or make changes to your plan outside of open enrollment if you meet certain criteria. This is called a special enrollment period and usually requires you to act within 60 days of the qualifying event. If you get your insurance through your employer, the rules are different, you only have 30 days and you should review Qualifying Life Events for Employer-Sponsored Insurance.
Common Qualifying Life Events in the Individual & Family Marketplace Include:
- Uninsured and needing coverage due to the COVID-19 pandemic
- Lost or will soon lose comprehensive health coverage
- Getting married or entering into a legal domestic partnership
- Becoming pregnant
- Change in family size (pregnancy, birth, adoption, foster child)
- Getting a divorce, legally separating or terminating a legal domestic partnership
- Becoming a District resident
- Gaining citizenship or a lawful presence in the US
- Release from incarceration (jail or prison)
Remember - you must report these events within 60 days.
If you currently receive financial assistance such as Medicaid, tax credits or cost-sharing reductions, you should report changes in income along with any life events immediately.
- If your income increases or you lose a member of your household, you may qualify for less assistance. If you don't report these changes, you may have to pay money back when you file your federal tax return.
- If your income decreases or you gain a member of your household, you may qualify for additional savings that can lower your costs even more.
If you're a member of a federally recognized tribe or an Alaskan Native Claims Settlement Act (ANCSA) Corporation shareholder, you're eligible for enhanced benefits and protections.
- You can enroll anytime during the year.
- You're also eligible for additional savings when you apply for assistance.
These are only some of the reasons you may qualify for a special enrollment period. To report changes or to see if you qualify for a special enrollment period, login to your account at dchealthlink.com or call us at (855) 532-5465.