Marketplace Enrollment Periods

Do I have to prove eligibility for a special enrollment period?

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Yes, in some cases. When you apply for Marketplace coverage and qualify for a Special Enrollment Period, the Exchange may request additional documents to confirm that you qualify for coverage in your Marketplace Eligibility notice.

If you apply for Marketplace coverage following loss of other coverage, will let you select a health plan but will delay the effective date of coverage while it verifies your loss of other coverage. If the Marketplace cannot automatically verify your other coverage loss using electronic data sources, you will have 30 days to provide documentation. will tell you what documents are acceptable to verify your eligibility for the SEP and how to submit them.  Once the Marketplace verifies your eligibility, you will be able to complete enrollment in the plan you selected. Keep in mind that only one person in a household applying for coverage or financial assistance through the Exchange must qualify for a SEP in order for the entire household to qualify for the SEP.

It Is very Important to act quickly to complete this verification process.  If you do not submit the required documentation within 30 days, your plan selection may be cancelled.  You can reapply for the SEP and restart the verification process if your qualifying event was less than 60 days ago.

If you submit documentation on time but the Marketplace determines it to be insufficient, you can apply for an extension of the 30-day review period to submit additional documentation.  However, you cannot apply for an extension of your special enrollment period.  If your eligibility is not verified by the end of your 60-day SEP, your plan selection will be cancelled and you will not be able to enroll until the next open enrollment period.



While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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