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medicare part d

What is a special enrollment period (SEP) and what qualifies a consumer for an SEP?

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ANSWER

A special enrollment period (SEP) is a time outside the annual Open Enrollment period when individuals may enroll in or change qualified health plans (QHPs). Individuals qualify for SEPs based on certain life events. Note that consumers can also qualify for a SEP during Open Enrollment; in certain situations, such as a SEP due to the birth of a child, a SEP during Open Enrollment can allow qualifying consumers’ coverage to start sooner than it would have if they had enrolled during Open Enrollment without the SEP.

Events that permit a SEP include:

  • The end of medical coverage that meets certain requirements Loss of coverage owing to unpaid premiums are not covered by this SEP.
  • Shifts in family composition.
  • Having new qualified health plan options become available due to a change in the principal residence.
  • Adjustments to Marketplace insurance or financial aid eligibility.
  • Faulty membership application or insurance coverage.
  • Not the norm, and other similar cases.

 

The typical enrollment window for coverage is 60 days after the date of the qualifying occurrence. Documentation of SEP eligibility may be required if the consumer is enrolling in Marketplace coverage for the first time. Native Alaskans and members of federally recognized Indian tribes can enroll in or switch plans once per month throughout the year.

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