March 16, 2017

As of the time of this writing which, ironically, comes one week after the American Health Care Act was introduced, the only compliance-friendly way of purchasing traditional health insurance is under the ACA Special Enrollment provision. If the term is new you, Special Enrollment is a section of the Affordable Care Act which allows those making significant life changes, the opportunity to buy or modify coverage outside the fixed Open Enrollment period.

Do I Qualify for Special Enrollment

The most common scenarios under which an individual or family would qualify for Special Enrollment include, but not limited to the following criteria:

  • Getting married or divorced
  • Welcoming a new baby or adopting a child
  • Changing jobs / leaving a company group plan
  • Moving to an area outside your geographic rating area
  • Starting a business of your own (read more about group plans)
  • The passing of a dependent in family, spouse or plus-child(ren) plans

While most of these qualifications are rather self-explanatory, there are some things that often go overlooked when determining whether your specific circumstance will qualify.  Let's examine a couple of the most relevant when gauging your eligibility, and what's next if you're ready to get started.

Buying Health Insurance After You Move

Not everyone who moves will qualify for Special Enrollment, and it's all about rating areas.  Premiums are determined by a wide range of factors, including where you live and the collective health of others in your area.  So if you're moving across town, you might not qualify.  Counties and provider networks are two of the foremost criteria in determining rating factors, so the further you move, the more likely you are to qualify.  Those moving outside their county, state, region of the country, etc are typically granted approval for SE.

Marriage, Divorce and Separations

We mention this only because there are some limited scenarios in which one would not qualify.  While getting married or divorced is one of the core conditions of Special Enrollment, things get trickier with separations.  If you're legally separated, the ACA essentially looks at it as a divorce on paper. 

If the separation is verbal, more casual or non-legally binding, you might have a more difficult time buying coverage.  Talk to your local agent to find out for sure, as there's a lot of gray area here.

Where to Begin the Special Enrollment Process

If you're confident that you're a shoe-in for Special Enrollment, you have a few options when it comes to signing up.  The very savvy and/or experienced can call or logon to either the carrier's website or the healthcare marketplace and begin the process.  If this is your first go at Special Enrollment, we strongly encourage you to consider working with an agent.  Most don't charge any fees for the SE application & support services, and the sheer volume of time saved can't be overstated.

Complimentary Special Enrollment Services for IL Residents

If you're in the state of Illinois and would like free assistance from an established health insurance agent with extensive Special Enrollment experience, Premier in Lisle can help. We're located near the Lisle Naperville corporate district, and staff licensed IL agents who can assist with applications, documentation, carrier communications, ID cards and more.

To get started or speak with an agent right now, call Premier at 800-369-0287 or write to us through our secure contact page.