Do I have to prove eligibility for a special enrollment period?

Yes, in most states.  The federal Marketplace (HealthCare.gov) requires people to provide documentation of eligibility for special enrollment before you can enroll in coverage.  Pre-enrollment verification is required for the following qualifying events:

  • Loss of minimum essential coverage
  • Permanent move
  • Marriage
  • Adoption, placement for adoption, placement for foster care, or child support or other court order, and

If you experience one of these qualifying events and apply for coverage in a federal Marketplace state, HealthCare.gov will let you select a health plan, but will delay the effective date of coverage while it verifies your eligibility for the SEP.

HealthCare.gov will tell you what documents are acceptable to verify your eligibility for the SEP and how to submit them.  Once you apply for the SEP and select a health plan, you will have 30 days to provide documentation to the Marketplace.  Once the Marketplace verifies your eligibility, you will be able to complete enrollment in the plan you selected.

It is very important to act quickly to complete this verification process.  If you do not submit the required documentation within 30 days, your plan selection will be cancelled and you will no longer be eligible for the SEP.

If you submit documentation on time but the Marketplace determines it to be insufficient, you can apply for an extension of the 30-day review period to submit additional documentation.  However, you cannot apply for an extension of your special enrollment period.  If your eligibility is not verified by the end of your 60-day SEP, your plan selection will be cancelled and you will not be able to enroll until the next open enrollment period.

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