Special Enrollment Period (SEP) in Michigan

A new Michigan address? Welcoming a new family member? Transitioning between job roles? The state of Michigan offers a range of options to cater to your healthcare needs. Events such as these, among others, might render you eligible for a special enrollment period (SEP), even outside the designated Open Enrollment period. 

So, what are certain events that may qualify for a Special Enrollment (SEP) in Michigan?

Loss of Current Michigan Healthcare Coverage (Involuntary) 

The coverage being relinquished must qualify as minimum essential coverage, and the termination must be non-voluntary in nature. Termination of the plan or failure to meet premium payments is not considered an involuntary loss. However, departing from employment voluntarily, resulting in the forfeiture of group employer-sponsored health coverage, is deemed an involuntary loss of coverage. Generally, the discontinuation of coverage that doesn't meet the criteria for minimum essential coverage does not initiate a special open enrollment period.

An exception applies to pregnancy Medicaid, CHIP unborn child, and Medically Needy Medicaid cases. 

Becoming a Dependent, or Adding a Dependent 

The event of acquiring or adding a dependent through birth, adoption, or placement in foster care constitutes a qualifying life event. Coverage is retroactively applied to the actual date of birth, adoption, or foster care placement. 

Getting Married 

Upon marriage, a designated 60-day interval for open enrollment is initiated, commencing from the day of the union. 

Divorce 

In the event of the dissolution of a marriage leading to the loss of existing health insurance, an individual becomes eligible for a specialized open enrollment period in accordance with the loss of coverage provision.

Income Increases that throw you out of the Coverage Gap 

Currently, across 11 states, an existing gap in Medicaid coverage persists, leading to an approximate count of 2 million individuals who remain devoid of the opportunity to attain affordable health coverage.

Acquiring Eligibility for a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or an Individual Coverage Health Reimbursement Arrangement (ICHRA) becomes Feasible. 

This newly instituted special enrollment period was introduced in the year 2020, following the guidelines outlined in the health reimbursement arrangement regulations established during the Trump administration. These regulations pertain to the reimbursement of employees for their individual market coverage expenses through mechanisms such as the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). QSEHRAs were made available in 2017' as a component of the 21st Century Cures Act, facilitating small-scale employers in providing reimbursement for individual market coverage expenses within limits set by the IRS. It is noteworthy that prior to the year 2020', there was no designated special enrollment period for individuals who gained eligibility for a QSEHRA. 

Circumstances resulting in Newfound Eligibility (or ineligibility) for Subsidies or Cost-Sharing Reductions (CSR), along with an Income not surpassing 150% of the poverty threshold. 

Should there be a modification in your income or circumstances that result in your recent qualification or disqualification for premium tax credits, or if you attain new eligibility for cost-sharing subsidies, you will be afforded the chance to make changes to your chosen plans. 

Individual (or family) plans to renew outside of Open Enrollment 

In late May 2014', the Department of Health and Human Services (HHS) issued a regulatory directive incorporating a provision to facilitate a special open enrollment period for individuals whose health plans are undergoing renewal, while not undergoing termination, outside the customary open enrollment timeframe. While ACA-compliant plans typically adhere to a calendar-year cycle, this is not universally applicable to both grand-mothered and grandfathered plans, nor does it consistently apply to employer-sponsored plans. 

Becoming a U.S. Citizen 

A Permanent Move

This enrollment period is applicable when a relocation is undertaken to an area with a distinct array of qualified health plans (QHPs) that are offered. It is important to note that this specialized enrollment period is accessible to applicants who have maintained active minimum essential coverage for a minimum of one out of the preceding 60 days (about 2 months) prior to the relocation event.  

An Error with the Enrollment 

In instances where enrollment oversight (or absence of enrollment, as applicable) can be attributed to the exchange, the Department of Health and Human Services (HHS), or an enrollment assister, may issue a special enrollment period to be conferred exists. 

Employer-sponsored Plan undergoes a Situation of Becoming Financially Unaffordable or ceases to offer Minimum Essential Coverage 

For the year 2023’, an employer-group sponsored plan is deemed “affordable” if the employee's sole responsibility for the coverage portion does not exceed 9.83% of their total household income. 

Additionally, a plan is considered to offer minimum value if it encompasses a minimum of 60% of anticipated expenses for a standard cross-section of the population, coupled with substantial coverage for both inpatient and physician services.

It is noteworthy to acknowledge that the Department of Health and Human Services (HHS) initiated an enhanced approach to overseeing special enrollment period eligibility in 2016', following concerns that the enforcement of these provisions had previously exhibited a degree of leniency. 

In the month of February 2016’, HHS officially communicated its intent to mandate the provision of substantiating evidence to validate eligibility as a prerequisite for the approval of special enrollment periods activated by events such as birth, adoption, placement for adoption, permanent relocation, loss of alternate coverage, and marriage. It is important to recognize that these events encompass a significant majority of qualifying life events within states 

under the jurisdiction of Healthcare.gov. 

This trajectory of bolstered eligibility verification was further intensified in the subsequent year of 2017, facilitated by the implementation of "market stabilization" regulations that HHS finalized in the month of April that year.

If you need more help with your Michigan SEP question, make sure to reach out to the agency today!