Q. My son is covered on my employer’s policy through July 31, but because he’s turning 26, he’ll have to find his own coverage. Can he enroll in a new plan with coverage starting on August 1?
A: Loss of existing coverage – as long as it is minimum essential coverage – triggers a special enrollment period. So your son will be able to enroll in an individual Marketplace plan with an August 1 effective date.
(To clarify, all employer-sponsored plans are, by definition, considered minimum essential coverage.1 This is true regardless of the quality of the employer’s plan, so loss of employer-sponsored coverage will always trigger a special enrollment period.)
Because his triggering event is the loss of eligibility for an employer-sponsored plan, his open enrollment window begins 60 days before his coverage ends, and continues for 60 days after it ends (Federal regulations code 155.420(d)(6)(iii) explains the details). So he can apply before his current policy ends, to have seamless coverage.
The special open enrollment window also allows him to enroll at any time in the 60 days after his existing policy ends, but he would have a gap in coverage, since his new plan will take effect the first of the month following his enrollment.
So if he were to apply in the 60 days prior to July 31, his new policy will be effective August 1. If he applies in August, his new policy will be effective September 1. His opportunity to enroll would also continue into September, but the new coverage wouldn’t be effective until October 1, leaving him with a two-month gap in coverage.
If he’s eligible for COBRA, he has the option to temporarily extend his group coverage. Learn about the pros and cons of COBRA versus an individual market plan.
Footnotes
- ”Minimum Essential Coverage” CMS.gov. Accessed Dec. 5, 2024 ⤶
