Do you qualify for the Special Enrollment Period?
If you qualify for a Special Enrollment Period, you can enroll in health insurance outside the annual Open Enrollment period.
You qualify for a Special Enrollment Period (SEP) if you’ve had certain life changes like getting married, having a baby, or losing job-based health insurance. These are called “qualifying life events.”
In addition to these events, if you had to pay a Tax Penalty this year for not having Health Care Coverage you may qualify for special enrollment. This Special Enrollment Period was put in to place to help consumers avoid Tax Penalties for not obtaining health insurance coverage this year.
You can qualify for a special enrollment period if any of the following applies to you:
- Coverage can take effect: The first day of the month after you enroll
- Enrollment window: Up to 60 days after your marriage. (You can’t enroll until after the marriage.)
Having a Child
- Having a baby, adopting a child, or placing a child for adoption
- Coverage can take effect: The day of the event
- Enrollment window: Up to 60 days after the event
Turning 26 Years Old
- Aging off a parent’s coverage at 26
Losing Current Health Care Coverage
- This could include losing a job-based plan, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events:
- Coverage can take effect: The first day of the month after you enroll and after the loss of coverage
- Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or any plan that doesn’t qualify as minimum essential coverage.
New to Illinois
- First time resident of Illinois
- Returning to Illinois as a resident
Tax Penalty Chart
These are the penalties for not having health care coverage. The penalty is either calculated by a flat rate or a percentage of your taxable income, whichever is highest.
Other qualifying life events
In addition to the situations above, the following life events also qualify you for a Special Enrollment Period. But if they happen during Open Enrollment, your coverage can’t start any sooner than it would without an SEP.
- Moving your residence outside your insurance plan’s service area
- Gaining citizenship
- Gaining status as member of a federally recognized tribe or shareholder in an Alaska Native Claims Settlement Act (ANCSA) Corporation. Members of federally recognized Indian tribes can enroll in or change plans once a month throughout the year.
- Leaving incarceration
- For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
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