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Special Enrollment Periods: What They Are and How You Qualify | RMHP Blog

Special Enrollment Periods: What They Are and How You Qualify | RMHP Blog



There are certain times each year when you can shop for and enroll in individual and family health insurance plans or Medicare coverage. These timeframes are called the Open Enrollment Period (for individual and family plans) and the Annual Enrollment Period (for Medicare coverage).

Life changes happen, though, and you may experience an event during the year, like having a baby or losing other coverage, that requires you to enroll in a new plan or make changes to your existing one.

Certain situations like these may qualify you for a Special Enrollment Period.

Individual & Family Health Insurance Special Enrollment Periods

The Open Enrollment Period for individual and family health insurance coverage in Colorado is November 1 through January 15 each year. During this time, you can enroll in or change your plan either with a private insurance carrier like RMHP or through Connect for Health Colorado, the state’s health insurance marketplace.

There are other opportunities throughout the year when you can enroll, though, if you qualify for a Special Enrollment Period. There are many qualifying life events that make you eligible for a Special Enrollment Period.

Family additions or changes

  • Birth of a baby, adoption of a child, or placement of a child for foster care
  • Getting married or divorced
  • Death of a household member enrolled in a plan

Loss of health insurance coverage

  • You lost health insurance from your job
  • You no longer qualify for Health First Colorado (Colorado’s Medicaid program)
  • You no longer qualify for Medicare Part A
  • You turn 26 and age off your parents’ plan
  • Your student health plan ended
  • Loss of COBRA subsidy

Move or change in permanent residence

  • Move to Colorado
  • Move to a new permanent address (certain conditions apply)
  • Leave incarceration
  • Gain of lawful presence (i.e., legally living in the United States according to federal immigration laws)

Changes to income

For current enrollees only:

For new customers only:

  • Your household’s income is equal to or less than 150 percent of the federal poverty level ($19,320/year for an individual, $39,750/year for a family of four)

Be sure to report changes in your household size, income, or address within 30 days of the change. You may be asked to provide proof of the qualifying life event.

Medicare Special Enrollment Periods

You can apply for Medicare during a few different timeframes. Your first opportunity is during your Initial Enrollment Period when you turn 65. The Annual Enrollment Period is October 15 through December 7 each year, during which you can enroll in Medicare or change your plan. There are also situations that may qualify you for a Medicare Special Enrollment Period.

You have health insurance through your employer and are still working. You can sign up for Part A and Part B any time as long as:

  • You have group health plan coverage
  • You or your spouse (or a family member if you’re disabled) is working for the employer that provides your health coverage

You have eight months to sign up after you or your spouse (or your family member if you’re disabled) stop working or you lose group health plan coverage (whichever happens first).

Your eight-month Medicare Special Enrollment Period starts when you stop working, even if you choose COBRA or other coverage that’s not Medicare.

  • You’re a volunteer serving in a foreign country.
  • Certain situations apply for people with TRICARE. Contact TRICARE for more information.

Coverage generally begins the month after you sign up during a Medicare Special Enrollment Period.

Get Answers to Your Questions

We know health insurance can be confusing, and we’re here to help. Contact RMHP today to learn more about Special Enrollment Periods and to see if you may qualify.