How States Are Increasing Coverage through Special Enrollment Periods
Updated September 28, 2020
Absent a pandemic, enrollees usually sign up for insurance coverage during the annual open enrollment period, from Nov. 1- Dec. 15. However, under extenuating circumstances, consumers can sign up during a special enrollment period (SEP). The Affordable Care Act defined a set of events that trigger SEPs nationally (view a national list of SEPs), but state-based marketplaces have limited discretion over when to schedule additional SEPs for their consumers. Many have enacted SEPs in response to the COVID-19 pandemic to give uninsured residents an opportunity for coverage, which reduces financial barriers in the event they need medical care. Below is a list of the unique SEPs available in state-based marketplaces, including life-changing events, unexpected health plan changes, or enrollment in dental coverage.
| What Events Qualify for a Special Enrollment Period in State-Based Marketplaces | |||||||||||||
| Qualifying Event | CA | CO | CT | DC | ID | MD | MA | MN | NV | NY | RI | VT | WA |
| Special Enrollment Periods (SEPs) triggered by unique life events: | |||||||||||||
| Loss of coverage upon leaving military service | x | ||||||||||||
| Loss of “hardship exemption” (exemption from individual mandate penalty) | x | x | x | x | |||||||||
| A change in disability status | x | x | |||||||||||
| Pregnancy (self-attested or requiring verification) | x | x | x | x | x | ||||||||
| Newly eligible for state coverage because of change in income | x | ||||||||||||
| Beginning or end of state hardship waiver that reduces or waives premiums | x | ||||||||||||
| SEPs triggered due to insurance market changes: | |||||||||||||
| Health insurance plan became decertified during the coverage year | x | x | |||||||||||
| Provider left health plan network while enrollee was receiving care or treatment for illness | x | ||||||||||||
| SEPs due to eligibility/ reconciliation issues: | |||||||||||||
| Was conditionally approved for Medicaid during open enrollment period (OEP) or SEP, but was ultimately denied and received denial notice after the OEP/SEP ended | x | x | x | x | |||||||||
| Enrollee was automatically renewed into a different plan without forewarning because original plan was no longer offered | x | ||||||||||||
| Consumer’s employer was going to enroll employees in SHOP coverage, but was denied because too few employees selected coverage | x | ||||||||||||
| Tax filer learned of state/district individual mandate during tax season or was assessed a tax penalty through the mandate | x | x | x | ||||||||||
| SEPs due to technical issues or extenuating circumstances: | |||||||||||||
| SEP triggered for victims of a natural disaster (ex., wildfires). | x | ||||||||||||
| Loss of coverage due to the failure of a provider/provider-funded third party to pay enrollee’s premium on a timely basis (effective 7/1/2020) | x | ||||||||||||
| Termination of coverage caused by a problem with automatic payment (e.g., because credit card was discontinued because of fraudulent activity) | x | x | |||||||||||
| Acts of foreign or domestic terror prevented enrollee from meeting enrollment deadlines | x | x | |||||||||||
| SEP triggered in the event of a public health emergency* | x | x | x | x | x | x | x | x | x | x | x | x | |
| Customer’s enrollment issue (non-system error) was not resolved before the end of OEP | x | x | x | x | |||||||||
| SEPs triggered by fraudulent coverage: | |||||||||||||
| Purchased fraudulent coverage policy through Simple Health insurance company (temporary; expired) | x | x | x | x | x | x | x | ||||||
| Bought other fraudulent coverage (e.g., coverage that misrepresented itself as comprehensive coverage) | x | ||||||||||||
| Member of Aliera “health-sharing ministry” and wished to switch to comprehensive plan (temporary; expired) | x | x | |||||||||||
| SEPs for enrollment in dental plan: | |||||||||||||
| Consumer is newly eligible for Medicaid or qualified health plan, enrolled in SHOP, or gained access to an excepted benefits health reimbursement arrangement and otherwise lacks dental coverage | x | ||||||||||||
| Open SEP to purchase dental coverage | x | ||||||||||||
| Loss of other dental coverage | x | ||||||||||||
Updated September 28, 2020
*Time-limited SEPs created in response to the COVID-19 national emergency. These SEPs are/were open during the following periods.
CA 3/20/20 – 8/31/20
CO 3/20/20 – 4/30/20
CT 3/19/20 – 4/17/20
DC 3/18/20 – 9/15/20
MD 3/16/20 – 7/15/20; 8/7/20-12/15/20
MA 3/11/20 – 5/25/20
MN 3/23/20 – 4/21/20
NV 3/17/20 – 5/15/20
NY 3/16/20 – 9/15/20
RI 3/14/20 – 4/30/20
VT 3/20/20 – 6/15/20
WA 3/09/20 – 5/08/20
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
