By Trish Pearson
Insure Your Future
Trish Pearson
In the insurance world, a special enrollment period means the time when someone can enroll or change insurance plans outside of the open enrollment period. To qualify for a SEP, you must meet certain conditions – the insurance industry defines those as “life-changing events.”
These events fall into five basic categories: loss of group (employer) benefits, moving from one state to another, death of a spouse, marriage or birth of a child. There are certain additional instances when someone qualifies for a SEP if they are on Medicare or Medicaid (HUSKY in Connecticut).
When one of these life-changing events occurs, an individual has 60 days to choose an insurance plan through Access Health CT. The application can be completed online through AHCT.org, over the phone or by calling a certified broker who can assist with the application as well as advise on plan choice.
People who are on Medicare can also qualify for a SEP if they have a hospital stay and are then released or are in a rehab or a nursing facility. Also, when someone turns 65 they have an initial enrollment period of seven months to enroll in Medicare A and B as well as a prescription drug plan.
Many people think they must enroll in Medicare when they turn 65; this is not the case. If you have health insurance through an employer you can remain on that plan until retirement. It is recommended that you enroll in Medicare Part A as it will be a secondary insurance if you are in the hospital. There is no cost for Part A, and it will shorten the application process when you apply for full Medicare. People on Medicare also have a three-month period – January through March – of each year to make a change from one Medicare Advantage plan to a different one, or to go back to traditional Medicare with a supplement and standalone prescription drug plan.
Another SEP opportunity is for Medicaid members who no longer qualify because their income has increased. People who are no longer eligible for HUSKY have 120 days to enroll in a plan through Access Health CT. The next step is to contact Access Health or a certified broker who can assist with the application process. Note – even if their income has not changed, those who are receiving HUSKY benefits must renew their coverage by confirming their income with Access Health when they receive a renewal notice. This can be done online or on the phone. Failure to respond to the renewal request could result in cancellation of HUSKY.
Pregnancy also creates a SEP to cover the mother and the baby. Usually the child qualifies for HUSKY automatically, as does the mother for a period of time.
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or trishpearson281@gmail.com.