Special Enrollment Periods
Outside Open Enrollment, you can enroll in a private insurance plan on Your Health Idaho if you qualify for a special enrollment period. You can apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any time.
To qualify for a special enrollment period, one of the following must apply to you:
- You have a complex situation related to applying for coverage in the Health Insurance Marketplace. See more details below.
- You have a qualifying life event like change in marital status, having a baby, moving to a new area, or losing other health coverage. See more details below.
- If you applied for and received an eligibility determination that you were NOT eligible for Medicaid before March 31st but did not receive information from the Marketplace about how to proceed with applying for a Marketplace plan before the close of open enrollment, you also qualify for the “limited circumstances” Special Enrollment Period.
Additional events for those enrolled through Your Health Idaho:
- Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
- Gaining status as member of an Indian tribe
If you think you qualify for a special enrollment period, start the process now.
- Complete Special Enrollment Online: Login to your application online and conduct the special enrollment process online. NOTE: If you have a complex situation you will need to confirm online that you were still trying to enroll on March 31. CLICK HERE
- Complete special enrollment with an agent, broker or In-Person Assister: Find an agent, broker or In-Person Assister in Idaho that can help you with the special enrollment process at no cost to you. You can find assistance by calling our Consumer Resource Center at 1 (855) YH-IDAHO (1 (855) 944-3246) or by using our Consumer Connector Locator online.
- Complete Special Enrollment Over the Phone: Contact the call center at 1 (800) 318-2596 to complete your enrollment over the phone. NOTE: If you have a complex situation tell the representative of that situation when you call to enroll.
Special Enrollment Period for Idahoans Currently Enrolled in COBRA Announced
The Centers for Medicare and Medicaid recently announced a new Special Enrollment Period for individuals and families that are currently enrolled in COBRA continuation coverage, known as the federal Consolidated Omnibus Budget Reconciliation Act.
If you currently have COBRA continuation coverage, you may qualify for a Special Enrollment Period for a limited time only. This allows you to enroll in a Marketplace plan instead. In order to take advantage of this one-time Special Enrollment Period, you must enroll in a new plan by July 1, 2014.
To do this, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) or contact an agent or broker. Explain that you’re calling about COBRA benefits and the Marketplace. Please note: you must call to activate this Special Enrollment Period. It is not available online.
After you’ve been approved for a Special Enrollment Period, you can apply for and enroll in a Marketplace plan either online or by phone.
If you don’t enroll in a new plan by July 1, the rules stated on HealthCare.gov will apply. You won’t qualify for a Special Enrollment Period to get a Marketplace plan outside Open Enrollment until your COBRA expires or until start of 2015 Open Enrollment for a January 1, 2015 effective date of coverage, or unless you qualify for a Special Enrollment Period otherwise.
For more information on COBRA continuation coverage, please click here.
Below are cases and examples in addition to qualifying life events that may also qualify you for a special enrollment period.
You faced a serious medical condition or natural disaster that kept you from enrolling. For example:
- An unexpected hospitalization or temporary cognitive disability
- A natural disaster, such as an earthquake, massive flooding, or hurricane
- A planned Marketplace system outage, such as Social Security Administration system outage
Misinformation or misrepresentation
Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:
- Not getting enrolled in a plan
- Being enrolled in the wrong plan
- Not getting the premium tax credit or cost-sharing reduction you were eligible for
Your application may have been rejected by the insurance company’s system because of errors in reading the data, or some of the data was missing or inaccurate.
System errors related to immigration status
An error in the processing of applications or system caused you to get an incorrect immigration eligibility result when you tried to apply for coverage.
Display errors on HealthCare.gov
Incorrect plan data was displayed at the time that you selected your health plan, such as benefit or cost-sharing information. This includes issues where some consumers were allowed to enroll in plans offered in a different area, or enroll in plans that don’t allow certain categories of family relationships to enroll together.
- If you applied for Medicaid through your state, or were sent to Medicaid from the Marketplace, but you weren’t eligible for Medicaid.
- Your state transferred your information to the Marketplace but you didn’t get an answer about your eligibility and/or didn’t get enrolled before March 31.
You’re working with a caseworker on an enrollment issue that didn’t get resolved before March 31.
Victims of domestic abuse
You’re a victim of domestic abuse and weren’t previously allowed to enroll and receive advance payments of the premium tax credit separately from your spouse. You’ll be able to do so now.
Other system errors
Other system errors that kept you from enrolling, as determined by the Centers for Medicare & Medicaid Services
Qualifying Life Events
Events that create a special enrollment period include:
- Getting married
- Having, adopting, or placement of a child
- Permanently moving to a new area that offers different health plan options
- Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
- For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions