Open enrollment for Covered California health plans has come and gone; however, some people may qualify for special enrollment, including those who have a “qualifying life event” or have experienced a complex situation related to applying in the Marketplace. Below, your trusted California insurance agent explains some of the qualifying life events and circumstances for the special enrollment period in Covered California.
Qualifying Life Events
Following are some of the life events that may qualify a person for special enrollment in Covered California. Please note that this is not an exhaustive list.
- Getting married or entering in a domestic partnership
- Having a baby, adopting a child, or placing a child in adoption or foster care
- Losing your job-based coverage, becoming ineligible for Medi-Cal, or exhausting COBRA continuation coverage (note that not paying a COBRA premium and subsequently losing coverage does not qualify you for special enrollment)
- Moving to California (permanently) or being released from jail or prison in California
- A change in income that makes you newly eligible for help paying for insurance
- Becoming a citizen, national, or lawfully present individual
- Being a member of a federally recognized Indian or Alaska Native tribe.
Complex Situations Related to Applying in the Marketplace
In addition to qualifying life events, some individuals may qualify for the special enrollment because of circumstances outside their control related to the application process. These include, but are not necessarily limited to:
- Applying for coverage prior to March 31 but getting denied by Medi-Cal after March 31
- Being incorrectly denied coverage through Covered California or Med-Cal (you may be required to file an appeal)
Additional reasons for special enrollment may include exceptional circumstances, such as an unexpected hospitalization, or a natural disaster, such as an earthquake or hurricane. Misconduct by a marketplace assister (e.g. an insurance navigator or insurance agent or broker) that resulted in a person not getting enrolled in a plan, being enrolled in the wrong plan, or not getting the premium tax credit or cost-sharing subsidy for which they were qualified are additional reasons a person may qualify for special enrollment. System errors such as those with the Covered California website or technical errors between the Marketplace and the insurance company are additional reasons.
Those who qualify for special enrollment must apply within 60 days of the date the qualifying event happened. If you think you may qualify for special enrollment, contact Benefit Packages immediately to find out with certainty and for answers to all your insurance questions.