By RMHP
An Open Enrollment Period is a time when all people can apply for, join, switch, or drop a health insurance plan. In Colorado, the Open Enrollment Period for individuals and families to apply for health insurance coverage is November 1st through January 15th. For Medicare recipients, the Open Enrollment Period, also known as the Annual Election Period (AEP), is from October 15th through December 7th each year.
You typically cannot sign up for health insurance coverage after an Open Enrollment Period is over, unless you qualify for a Special Enrollment Period.
A Special Enrollment Period is a period of time that falls outside of the Open Enrollment Period when people can enroll in a health insurance plan.
You will not qualify for a Special Enrollment Period simply because you forget to sign up for health insurance before the Open Enrollment deadline. To be eligible for a Special Enrollment Period, you must experience a Qualifying Life Event.
A Qualifying Life Event is a major life event that has led to a significant change in your situation.
There are four main categories of Qualifying Life Events for individual and family insurance. The first is a loss of health coverage, which can occur if you lose coverage through an employer or if you are no longer eligible for Medicaid, Medicare, or CHIP. Loss of health coverage could also occur if you turn 26 and are no longer covered by your parents’ health insurance plan.
The second category covers life events related to changes in your household. Examples of these events may include marriage, the birth of a baby, an adoption, or a death in the family.
Changes in your residence, such as moving to Colorado from another state or country, are also classified as Qualifying Life Events.
The final category covers all other types of Qualifying Life Events, such as becoming a U.S. citizen, experiencing a change in income that affects your eligibility for health insurance coverage, and being released from incarceration.
Similarly, Medicare beneficiaries may be eligible for a Special Enrollment Period when certain events happen. These events may include moving, including moving in or out of an institution (like a skilled nursing facility), changes to Medicaid or other coverage (like employer or union coverage, or TRICARE or VA coverage).
You may qualify for a Special Enrollment Period if you recently experienced one or more of these major life events.
You typically will not qualify for a Special Enrollment Period unless you experience a Qualifying Life Event. However, there are some exceptions to this rule.
This year, Medicare beneficiaries who were enrolled in RMHP’s Cost Plan in December 2020 qualify for a unique Special Enrollment Period that runs from now until February 28, 2021. Why? This Special Enrollment Period allows Cost Plan members extra time to join another Medicare plan because their Cost Plan ended. RMHP now offers Medicare Advantage Plans (Rocky Mountain Health Plans CareAdvantage and Rocky Mountain Health Plans DualCare Plus) in place of the former Medicare Cost Plan, so former Cost Plan members receive extra time to make the switch over to a new Medicare Advantage Plan.
This Special Enrollment Period will not occur every year. It is a one-time event that was established to help beneficiaries whose prior year plan’s contract is not renewed to make a smooth transition to a new plan.
There are certain conditions that you must meet before you can apply for coverage through a Special Enrollment Period. First, you must apply before a certain deadline, which will vary depending on the Qualifying Life Event.
For non-Medicare plans, you will have a specific window of time to enroll in or change your health insurance plan if you experience a Qualifying Life Event.
Deadlines for common Qualifying Life Events are:
It is important to have documentation ready that confirms your Qualifying Life Event. For example, you may need to submit your marriage license to prove you were recently married, or adoption documents to show that you recently adopted a child. For former Medicare Cost Plan members, you will need the official notice of non-renewal RMHP provided in October 2020.
The required documentation will vary depending on the Qualifying Life Event and the insurance itself. For this reason, it is best to reach out directly to our support team here at RMHP, or to the Connect For Health Colorado marketplace, for more information on applying for coverage through a Special Enrollment Period.
You will qualify for Medicare benefits once you turn 65 years old, but you don’t need to wait until your 65th birthday to enroll in a Medicare plan.
You can enroll in a Medicare plan for the first time during your Initial Enrollment Period, which is seven months long. Your Initial Enrollment Period will begin three months before your 65th birthday and end three months after your 65th birthday.
Already having health insurance coverage when you initially become eligible for Medicare means you may not need to enroll in Medicare until you lose that coverage. That being said, if you don’t already have coverage and you don’t enroll in a Medicare plan during this Initial Enrollment Period, you may be charged a late enrollment penalty every month once you do sign up. To avoid this penalty, make sure you enroll in a Medicare plan during your Initial Enrollment Period.
During the Medicare Advantage Open Enrollment Period, from January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.
Please get in touch with us if you think you may qualify for a Special Enrollment Period now or in the near future and we can go over your options together. Simply call us at 800-843-0719 and we'll be glad to help.