HSA for America

How Life Events Affect
Your Health Insurance Coverage

May 1, 2014
Vol. 10, Issue 5

Although you likely have health insurance coverage right now, you never know what might come up over the next year to cause your circumstances to change. You might be planning on getting married, you could unexpectedly lose your job, or maybe you have a baby on the way. These and many other events are described as “qualifying events” or “life events” and will qualify you to make changes to your health insurance coverage.

How to Qualify for a Special Enrollment Period

During the time outside the open enrollment period, you can’t sign up or change health plans unless you qualify for a special enrollment period (SEP). The next open enrollment period is not until November in most states. This is why it’s important to know your rights when you encounter one of the following qualifying events:

  • Marriage
  • Divorce
  • Having a baby (including adopting a child or having a child placed in your custody)
  • Losing health coverage (such as losing insurance due to loss of a job, divorce, or becoming ineligible for Medicaid)
  • A change in your income
  • Moving outside the area of your health plan
  • Newly gaining American citizenship
  • Display errors on enrollment websites (incorrect plan data information being displayed at time of enrollment)

It’s important to note that if you voluntary drop your insurance coverage or do not pay your premium, you will probably not qualify for a special enrollment period.

How Special Enrollment Periods Work

Most special enrollment periods only last for 60 days, so if you believe you qualify for a special enrollment period, you should take immediate action. Your 60 days typically begins the day of the qualifying event; however, in some instances, it may begin sooner. For example, if you receive notice that for any reason your current health coverage is about to be terminated, you special enrollment period begins 30 days before the termination date of your coverage and lasts for 30 days after your coverage terminates.

Once your advisor determines that you indeed qualify for a special enrollment period, they will assist you with adding or removing individuals from your plan or show you other plans that may best suit your new circumstances. They will also help you calculate your premium subsidy, if you qualify.

Is Your Health Plan Scheduled to Terminate in 2014?

Are you one of the millions of Americans who received a policy cancellation notice in 2013? After the last-minute “fix”, you may have been able to keep your plan until the policy renewal date in 2014. If this is the case, you will qualify for a special enrollment period. Be on the lookout for any information from your insurance company regarding your termination date so you can take swift action to avoid missing your special enrollment period.

In March, the Obama administration extended the time many individuals can keep their plan until 2016. We will keep our Web pages updated once we begin receiving notification from insurance carriers as to whether or not they will be extending plans and will also communicate to you directly via email once we have additional information.

Are Premium Subsidies Affected by Qualifying Events or Special Enrollment Periods?

Many circumstances could affect your premium subsidy, especially during a special enrollment period. Adding or removing a family member to your plan or a significant change in household income could significantly increase or decrease your premium subsidy, so it’s important that you report all changes as soon as possible.

Overpayments involving premium subsidies will be recouped by withholding future tax refunds, so it’s important you estimate your income as accurately as possible.

Where to Get Help With Your Special Enrollment Period

If you are unsure if you qualify for a special enrollment period or when your SEP begins, be sure to contact your HSA for America Personal Advisor. Just a couple weeks ago we were able to help a client with a Special Enrollment Period after they discovered that no local doctors would accept his Blue Cross plan. Our team is very well versed with special enrollment periods and will guide you through the entire process of updating or changing your health plan as necessary.

Your advisor will also calculate any increase or decrease in premium assistance, if you qualify. Because special enrollment periods last for a short period of time, you should contact your advisor as soon as you suspect you might qualify for an SEP.

I will continue to provide up-to-date information as it comes our way and encourage you to contact your HSA for America Personal Advisor or callus directly at 800-913-0172 if you have any questions about your health plan.

To your health and wealth!

"Hanging with my two favorite people"

Wiley Long
President - HSA for America




HSA for America
749 S. Lemay Ave, Suite A3-116
Fort Collins, CO 80524
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