Renewing Marketplace Coverage

My insurance company won’t offer any plans on the Marketplace next year. Do I qualify for a special enrollment period?

Yes.  However, if possible, follow the regular Open Enrollment process and deadlines to pick a new plan for next year.  If you pick a new plan by 3:00 am ET on December 18 and pay your January premium by the deadline the new insurer requires, then coverage under your new plan will take effect January 1.

Your current insurer’s exit from the Marketplace at the end of this year is considered a qualifying event that also makes you eligible for a Special Enrollment Period (SEP).  Therefore, you could use the SEP process instead to pick a new plan for next year.  This process can give you more time to make a plan selection, but it may also require additional steps and verifications and even result in a gap in coverage.

Under the SEP process you can elect new coverage any time during the 60 days leading up to your qualifying event date (January 1).  If you pick a new plan during this time (as late as December 31), you can also request that new coverage take effect on January 1, the day after your current coverage ends.  This is one key difference between the SEP and Open Enrollment processes.  Through Open Enrollment, in most states, you must pick your new plan by 3:00 am ET on December 18 for coverage to start on January 1.  Though the SEP process gives you a few more days to pick a plan that starts in January, remember that insurers typically handle a surge of new enrollments at year end, increasing the risk that SEP applications filed at the last minute might encounter delays or mistakes.

Under the SEP process, you can also elect new coverage at any time for 60 days following your qualifying event.  That means you could pick a new plan as late as March 1 – a month after Open Enrollment ends.   However, waiting this long means new coverage would begin as late as April 1, and you could be uninsured until then.

Finally, to use the SEP process, you must attest to your eligibility for the SEP and may be asked to provide documentation.  Be sure to save the notice from your current insurer, you may have to submit a copy of it to the Marketplace.  Failure to provide documentation of SEP eligibility, when it is requested, can result in your new coverage being cancelled.

If you have not selected a new health plan for next year by 3:00 am ET on December 18, you will receive additional notices from the Marketplace with more information about the SEP process.

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.