What is a Special Enrollment Period?

The annual Open Enrollment Period (OEP) runs from Nov. 1 through Jan. 15. During OEP, people can shop and enroll in a Marketplace plan and have coverage start on Jan. 1 or Feb. 1.

A Special Enrollment Period (SEP) is any time during or outside OEP for people who've gone through certain life events.

How long is a Special Enrollment Period?

If you have a qualifying life event (QLE), you can enroll for Individual and family health coverage during your SEP. Depending on the qualifying life event, you will have up to 60 days before or 60 days after to enroll in a plan during your SEP.

What you need to know

There are many rules around a Special Enrollment Period, but here are some important things to keep in mind:

  • Voluntarily canceling other health coverage or being terminated for not paying your premium is not considered a loss of coverage
  • Your coverage will start when you pick a plan, but you can't use your coverage until you confirm you qualify and you pay your first premium payment

What is a qualifying life event?

A Qualifying Life Event (QLE) is a change in your life situation that makes you eligible for a Special Enrollment Period (SEP). These events enable you to enroll in individual health coverage outside the annual Open Enrollment Period (OEP).

This list includes common situations that most people will use to qualify. After completing an application or enrolling in health coverage, you may receive an email with instructions on submitting documents to verify your QLE. Note that not all QLEs require documentation.

  • Loss of qualifying health coverage
  • COBRA coverage ending
  • Losing eligibility for Medicaid or CHIP
  • Turning 26 and aging off parent's plan
  • Marriage
  • Birth of a child or adoption
  • Foster care placement
  • Guardianship change
  • Moved to a different coverage area
  • Gained U.S. citizenship or immigration status
  • Death of policyholder
  • Leaving incarceration

We're here to help you navigate the process

We'll share special enrollment information and guidance to help you choose the best plan for your needs and budget. Learn about important deadlines, ways to save money and the steps to take before and after enrolling.

The SEP enrollment process

  1. Start with a free quote.
  2. Check the box to see if you qualify for a tax credit and we'll check if you're eligible for a premium tax credit and cost-sharing reductions.
  3. You'll see MyPriority plans available in your area, along with benefits and prices.
  4. When you're ready to enroll, click on the Enroll now button. You'll be guided through the process.

You can also call 833.979.3109 to talk to an enrollment specialist. They're ready to help you find the best plan for you and your family.

If you don't qualify for a Special Enrollment Period

If you don't have a qualifying life event, you can enroll in an Individual & family health plan during the annual Open Enrollment Period, Nov. 1 - Jan. 15. See our short-term plans, which may help until OEP starts.

If you were denied an SEP and disagree with the decision, you can appeal it within 90 days. Details can be found on healthcare.gov.

Additional savings may be available

  • When you shop, check the box to see if you qualify for additional savings, even if you don't think you're eligible.
  • When you get a quote, we'll check if you also qualify for extra savings through cost-sharing reductions. These lower your out-of-pocket expenses whenever you receive medical services.
  • You'll only find cost-sharing reductions on Silver plans, so you need to choose and buy a Silver plan to get them. They're worth checking out.
  • Remember that your household size and income may affect any subsidies or cost-sharing reductions.
pregnant mom on couch with ultrasound pictures
Bride and groom in limo smiling

How to choose a health plan

When searching for Individual health plans on the Marketplace, you'll come across a variety of choices.

It's wise to pick a health plan that fits your budget but don't rely only on your monthly premium to decide how much you'll pay every month.

Pay attention to the plan details, networks, deductibles, copays and extra benefits. Select a reliable and affordable plan that will support you when it matters most.

Learn how to compare health plans in our Learning Center.

Remember this important step after you enroll

After you complete your special enrollment, your work isn't quite done.

  • You'll find out if you have to provide documents to confirm a SEP after you submit your application. You'll have 30 days to send the documents.
  • You can't use your coverage until your eligibility is confirmed and you pay your first premium payment.
  • If your eligibility notice doesn't say you need to submit documents, you don't have to.
three women laughing on windy day on rocky shore

What you can expect from a MyPriority plan

Keep in mind, a deductible is the amount you pay before the health plan starts to pay for certain services. Learn more key terms you should know before shopping.
  • Preventive care is covered in full, before deductible: This includes physical exams, well-child visits, vaccines, screenings for breast, cervical and colon cancer and more.
  • Chronic condition coverage, before deductible: Our plans include supplies and prescriptions at zero or low cost to help manage chronic conditions, like diabetes, heart disease and asthma.
  • Low prescription copays: Prescriptions and medications are covered under our plans so you can save on out-of-pocket costs.
  • 24/7 virtual urgent care1: A great option for treating minor illnesses and injuries like ear infections, fevers, coughs, minor burns or bites.
  • On-demand mental health support: You'll have free access to Teladoc Health Mental Health, an online mental health and wellness tool.
  • Maternity care is covered in full, before deductible: Get the prenatal and postnatal care you need for your special delivery.
mom and dad with two young kids in front yard of home

Coverage that prioritizes you

 

  • One of the largest individual networks of primary care doctors in Lower Michigan and in metro Detroit
  • Narrow Network plan options to save you even more
  • Our four-star rating on the Health Insurance Marketplace2 shows that we give you more for your money and do more to improve your health
  • Local, award-winning customer service3 that makes your needs a priority
  • A Michigan-based company committed to investing in communities to improve health, instill humanity and inspire hope
  • Member discounts and rewards with zero-added cost

Qualify for a Special Enrollment Period?

Get a free quote now and see if you qualify for additional savings.