Special Enrollment Period

Special Enrollment Period 2017-11-01T06:07:58+00:00

Special Enrollment Period

The 2018 Open Enrollment period is November 1, 2017 through January 23, 2018. If you need coverage that starts before January 2018, you must experience a qualifying event, or are eligible for coverage you can enroll in any time of the year listed below.

If you need coverage now, you may qualify for coverage through the Health Connector if you experience certain life events (called “qualifying events”) may allow you to get coverage during a 60-day special enrollment period, even after Open Enrollment ends.

You can enroll any time of the year if:

  • You qualify for MassHealth.
  • You now qualify for a ConnectorCare plan through the Health Connector after not having qualified in the past, or after applying for the first time.
  • You are applying for dental coverage.
  • You are a member of a federally recognized tribe or Alaska Native shareholder.

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MassHealth Members

If you are a current MassHealth member and got a letter in the mail to renew your coverage, you can get started right away. You can use this website to submit an application so MassHealth can determine what you are eligible for based on your household size, income, and other factors. Click here to learn more and get started →

Types of Qualifying Events for Special Enrollment Period (SEP)

A Special Enrollment Period is a time outside of the open enrollment period that you and your family have a right to sign up for health coverage through the Health Connector. You may qualify for a special enrollment period 60 days following certain qualifying events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage.

Qualifying Events

  • Getting married.
  • Change in household dependents. Birth or adoption of a child, receiving a child into foster care, placing a child for adoption or foster care, or court-ordered care of a child.
  • Qualifying for ConnectorCare, after not applying or qualifying for it in the past
  • Losing minimum essential coverage. You may qualify for a special enrollment period if you lose health coverage for a reason other than not paying premiums or because of fraud. This includes:
    • loss of MassHealth coverage.
    • loss of your insurance from a job.
    • your COBRA coverage ending. Note: Not paying your COBRA premium is not considered loss of coverage.
    • no longer living or working in your health insurance carrier’s service area.
    • no longer qualifying for student health coverage.
    • the end of your dependent status on someone else’s plan.
    • turning 26 years old and no longer qualifying as a dependent in a family plan.
    • turning 19 years old and no longer qualifying for a child-only plan.
    • primary subscriber of your health insurance plan becomes eligible for Medicare.
    • having a claim that would meet or exceed a lifetime limit on all benefits;
    • death of a primary subscriber
  • Change in residency, such as a permanent move to Massachusetts, gains access to new plans as a result of a permanent move within the state, or release from jail or prison.
  • Is an American Indian or Alaska Native, as defined by section 4 of the Indian Self-Determination and Education Assistance Act. Such an individual may enroll in a health or dental plan or change from one plan to another once a month even if the open enrollment period is over.
  • Becomes a lawfully present individual but you were not lawfully present in the U.S. before.
  • Has a waiver from the Massachusetts Office of Patient Protection
  • Was mistakenly enrolled or not enrolled in a Health Connector health or dental plan due to an error, misrepresentation, or inaction on the part of the Health Connector or the Department of Health and Human Services, or its instrumentalities, as determined by the Health Connector.
  • Other exceptional circumstances

If you are already enrolled in coverage through the Health Connector:

  • Household income change resulting in you being eligible or ineligible for help paying for your insurance. For example, if you are already enrolled in coverage and your income goes down, you may be able to get extra help, like an Advance Premium Tax Credit.
  • Change in ConnectorCare plan types that you qualify for.

Quick Tips: Applying for coverage outside the open enrollment period

You must report changes and choose a plan within 60 days of the qualifying life event to buy a health insurance plan outside of open enrollment through the Health Connector.

You can enroll at any time of year:

  • If you qualify for MassHealth.
  • If you qualify for ConnectorCare after not applying or qualifying for it in the past.
  • If you are applying for dental insurance.
  • If you are a member of a federally recognized tribe or Alaska Native shareholder.
If you have any questions about qualifying events and special enrollment periods, please call Health Connector Customer Service at 1-877 MA ENROLL (1-877-623-6765), TTY: 1-877-623-7773. Help is available in all languages.

Enrolling in Coverage after a Qualifying Life Event

You have 60 days from the date when your qualifying life event happens to enroll in coverage or change  plans through the Health Connector. For example, if you have a child on July 12, you have until September 10, 2017 to

  1. Let the Health Connector know;
  2. Complete an application for coverage; and
  3. Shop and choose a new health plan.

If 60 days pass and you do not enroll in health coverage—and do not have another qualifying life event—you would have to wait until the next open enrollment period to enroll.

Remember that Massachusetts residents can enroll in MassHealth or ConnectorCare at any time, if they qualify.

You do not need to have a qualifying life event to enroll in MassHealth or if you are newly eligible for ConnectorCare plans. To find out if you are eligible for MassHealth or ConnectorCare, you can complete an online application.

  • You can apply online. Start at the “Getting Started Guide” →
  • By mail by completing a paper application. Go to the “Forms” section of the site to download one now.
  • By phone by calling the MassHealth or Health Connector Customer Service Center:
    • MassHealth Customer Service
      1-800-841-2900, or TTY 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled.
      Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m.
    • Health Connector Customer Service
      1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled.
      See our Open Enrollment hours →
  • In-person by making an appointment with an Enrollment Assister near your home. Search for one in your area now →
  • In-person at a MassHealth Enrollment Center or Health Connector Walk-in Center

MassHealth Enrollment Centers (no appointment needed):

  • Chelsea: 45-47 Spruce Street
  • Tewksbury: 367 East Street
  • Taunton: 21 Spring Street, Suite 4
  • Springfield: 88 Industry Avenue

Health Connector walk-in centers (no appointment needed):

  • Boston: 133 Portland Street, 1st Floor
  • Springfield: 88 Industry Avenue
  • Worcester: 146 Main Street, Suite 201/202
You will need to plan ahead to avoid a gap in health coverage. If you apply for coverage and qualify for MassHealth, coverage starts right away. But, if you apply for coverage and qualify for a Health Connector plan or ConnectorCare, you have until the 23rd of the month to apply, shop, and pay for coverage that starts the first day of the following month. For example, if you are losing coverage from a job on November 15, you would qualify for a special enrollment period and will need to apply, shop, and pay for a plan no later than November 23 through the Health Connector for a plan that starts December 1 and avoid a gap in coverage.

An exception to this is the birth or adoption of a child. You still have 60 days to add a dependent to your account, and coverage will date from the child’s date of birth or the date the adoption was finalized (see more below). Also, if you or members of your family are eligible for MassHealth, coverage can start right away.

In most cases, if you enroll in a plan during a Special Enrollment Period, the start date will depend on the qualifying event and the date of enrollment.

In general, if you enroll by the 23rd day of the month, then your coverage will start on the first day of the next month. If you enroll after the 23rd of the month, then your coverage would start on the first day of the second month.

Examples:

If you apply and enroll by October 23, 2017 Your coverage can start as soon as November 1, 2017
If you apply and enroll by October 24, 2017 Your coverage can start as soon as December 1, 2017

Some exceptions include:

  • If you apply and qualify for MassHealth, you coverage can start right away.
  • If you gave birth, adopted a child, or placed a child in adoption or foster care, their coverage starts on the date of the birth, the adoption or the placement for adoption or foster care. For example, if you had a baby on September 17, then you have up to November 16 to report that birth to the Health Connector. Coverage for the child will date back to September 17.
Please note that with any qualifying life event or reporting a change to existing coverage you may have through the Health Connector or MassHealth, you may be asked for documents as proof, which you will need to send to us within 90 days.

  • In the case of applying for coverage because your coverage through MassHealth ended this may mean sending a copy of the renewal notice you received, back to the Health Connector as proof.

Quick Tips: There are 4 ways to apply for coverage

Questions?

MassHealth Customer Service

1-800-841-2900, or TTY 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled.

Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m.

Health Connector Customer Service

1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled.

Hours: Monday through Friday, 8:00 a.m. to 6:00 p.m.