February 9, 2023
Open enrollment has ended for 2023, but some life events let people sign up for a health plan outside of open enrollment. This is called a special enrollment period. Here’s what you need to know about qualifying and how to help your clients apply.
What are qualifying life events?
Adding a dependent
- Marriage or domestic partnership
- Birth, adoption, or placement for adoption
- Foster care or binding court order
- Legal ward or guardianship
Losing a dependent
- Loss of coverage as a dependent as a result of death, divorce, or termination of a domestic partnership
- Reaching age 26
Loss of minimum essential coverage
- Loss of COBRA coverage
- Loss of employer-sponsored coverage
- Loss of coverage due to a permanent move
- Loss of coverage on Medicaid or another public program
Other events
- Being enrolled in a non-calendar-year plan that’s ending outside of open enrollment
- Change in your eligibility for tax credits and/or cost-sharing reductions
- System or human errors by your state or federal health plan
- Late eligibility
Cascade Care Savings
Washington Healthplanfinder now offers special enrollment to households that want to sign up for Cascade Care Savings. If you qualify, you’re given this benefit automatically. You may qualify for this special enrollment period if:
- Your income is less than 250% of the federal poverty level.
- You’re not enrolled in a Cascade Care plan
- You have limited income but don’t qualify for Apple Health
How long do my clients have to apply?
In most cases, your clients have 60 days from the qualifying life event date to apply for a health plan and provide the required documentation. Additionally, most qualifying events require proof of minimum essential coverage for at least 1 day of the last 60 days to qualify.
What documentation is required?
Your clients need to provide documentation of the qualifying life event. Documentation may include:
- Copy of marriage certificate or declaration of domestic partnership
- Copy of birth certificate, adoption or foster care papers, or guardianship appointment
- Copy of death certificate
- Copy of divorce decree or annulment papers, or affidavit of termination of domestic partnership
- Letter from the prior health plan company, employer, or COBRA showing proof that coverage was lost and the reason for termination
- Copy of utility bill at a new permanent address/rental or lease agreement showing prior address and new address
How can my clients learn more and apply?
If you think your client may be eligible, visit our Special Enrollment page for more details. Special enrollment occurs through Washington Healthplanfinder.