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Navigating the Special Enrollment Period

For many individuals and families, navigating healthcare enrollment and eligibility can often feel like a large and complex task. Whether it’s income amounts, household size, or supporting documentation, the list of “eligibility requirements” needed to qualify for affordable healthcare coverage can intimidate applicants.

The most common time to apply for (or change) healthcare coverage is during Open Enrollment. Open Enrollment usually takes place from November to January every year. Although this is a great time to explore new plans and available assistance, it isn’t the only time an individual or family can apply for coverage.

Outside of Open Enrollment, someone experiencing changes in health insurance coverage may qualify for a Special Enrollment Period (SEP), which could be the gateway to obtaining the healthcare they need.

What Is a “Special Enrollment Period”?

A “Special Enrollment Period” is a window of time outside of the annual Open Enrollment Period when individuals and families can sign up for health insurance through the Marketplace. Unlike Open Enrollment, Special Enrollment Periods are triggered by specific qualifying life events. This ensures that individuals who experience major life changes have the opportunity to secure or adjust their health coverage when needed.

What Qualifies You for a Special Enrollment Period?

Several circumstances can make you eligible for a Special Enrollment Period. These include:

  • Loss of Health Coverage: If you lose your employer-sponsored coverage, age out of a parent’s plan, or lose Medicaid or CHIP coverage, you may qualify for a SEP.
  • Household Changes: Life events such as marriage, divorce, the birth or adoption of a child, or the death of a family member may make you eligible.
  • Change of Residence: Moving to a new ZIP code or county, especially if it impacts your coverage options, may qualify you.
  • Exceptional Circumstances: Natural disasters or serious medical conditions that prevented enrollment during Open Enrollment may also grant eligibility.
  • Income Changes: If your household income changes, making you newly eligible for financial assistance or Medicaid, you might qualify.

      • It’s important to note that most qualifying events allow for a 60-day window to enroll in a plan or make changes to your existing coverage, although some may be longer.

      Our Navigators Can Help

      It’s already challenging enough learning how to navigate your health insurance options. When you add a major life change into the mix, it can feel even more overwhelming. That’s where our Navigators come in.

      Our team provides free, personalized assistance to help Tampa Bay residents:

      • Understand Their Options: We explain the different plans and subsidies available through the Marketplace and other resources.
      • Determine Eligibility: Not sure if you qualify for an SEP? Our Navigators can help assess your situation and determine your eligibility.
      • Complete Enrollment: From creating your Marketplace account to submitting the necessary documentation, we’ll guide you every step of the way.
      • Access Financial Assistance: Many people are unaware that they qualify for subsidies or cost-sharing reductions. We’ll help you uncover savings that make your healthcare more affordable.

        • Choose the Family Healthcare Foundation

        As a trusted non-profit in Tampa Bay, the Family Healthcare Foundation is committed to improving access to healthcare for all. Our services are always free, confidential, and tailored to your needs. By working with our Navigators, you’ll gain peace of mind knowing that you’re making informed decisions about your health coverage.

        What people are saying:

        “I want to give a big thank you to my Navigator for helping me get health insurance and even getting my rent paid for a month. I lost my job and had no idea how I was going to pay my bills or rent, plus I lost my health insurance. My Navigator got me signed up for the Hillsborough Plan and made sure my past-due rent for December was covered. THANK YOU!” – Jasmine

        “I am deeply grateful for my Navigator’s generous support during one of the most challenging times in my life. When I found myself facing financial hardship, the assistance she provided was a true lifesaver. Her kindness and compassion have lifted a tremendous burden from my shoulders, allowing me to focus on rebuilding and moving forward without the constant worry. I am beyond thankful for your organization’s dedication to helping others in times of need, and I will never forget the positive impact you’ve made in my life. You’ve renewed my hope and faith in the goodness of people and organizations like yours.” -Vanessa

        Take Action Today

        You might qualify for a Special Enrollment Period or want to explore your healthcare options – don’t wait. Our team of Navigators is ready to assist you! Click to make an appointment.

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