Lost your job? Had a kid? Got married? Life happens – and life changes allow for special health insurance enrollment opportunities.
There are two ways to enroll in coverage – even after the end of open enrollment.
- NUMBER ONE: If you qualify, you can apply for coverage for the Montana Medicaid or the Healthy Montana Kids programs. These programs have no open enrollment period.
- NUMBER TWO: You can buy private insurance after open enrollment if you qualify for a special enrollment period. There are two ways to trigger a special enrollment period. You must experience a qualifying life event or you must have experienced a complex life situation during open enrollment that prevented you from purchasing insurance during ordinary enrollment.
The Centers for Medicare & Medicaid Services (CMS) have posted a screener tool on healthcare.gov to help consumers know whether they are likely to be eligible for a special enrollment period or eligible for Medicaid and or CHIP, which is known in our state as Healthy Montana Kids. Use the tool
Qualifying life event
There are series of life changes that can re-open the door to purchasing health insurance. Typically, such events will trigger a window — usually 60 days from the triggering event — when you can buy private insurance at any time in the year.
Examples of qualifying life events:
- You get married.
- You adopt or give birth to a new baby.
- You move outside of your insurance company’s coverage area.
- You graduate from college – and lose your school sponsored plan.
- You age out of your parents’ plan. You can stay on your parents plan until age 26.
- You get divorced – and lose the insurance you had through your spouse.
- You lose your job – and with it your employer-sponsored plan.
- You age out of the Healthy Montana Kids program. That program provides coverage for children up to age 19.
- You lose eligibility for Medicaid or COBRA.
- You lose coverage due to death of a policyholder.
A more complete list of qualifying events can be found here. If you’ve experienced any kind of life change and aren’t sure if it qualifies you for a special enrollment period, we recommend you talk to a professional in your area.
There are other events that may qualify you for a special enrollment period:
- You experienced a hospitalization or temporary cognitive disability during the previous open enrollment period which prevented you from purchasing insurance.
- You experienced a natural disaster, such as massive flooding.
- The person assisting you in purchasing insurance – such as a navigator or insurance agent – committed misconduct which resulted in you not receiving a tax credit, enrolling in the wrong plan or failing to enroll, entirely.
- Your application was rejected by the insurance company because of data-reading problems or missing information.
This is a partial list. For more information about a complicated situation, consult the federal government’s website.
Montana Medicaid and Healthy Montana Kids
These programs are run by the Montana Department of Public Health and Human Services. For enrollment requirements and other information, contact the programs directly.