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Does divorce trigger a special enrollment period?
Access to an SEP due to divorce, death, or legal separation without an associated loss of coverage – is not available in most states. This SEP is not available in states that use HealthCare.gov1 (32 states as of 2024), and it’s only available in about half of the states that have state-run exchanges (details below).
Although this SEP was originally slated to be available nationwide, HHS ultimately decided not to offer it on HealthCare.gov, and to make it optional in states with state-run exchanges, giving the decision to the exchanges or applicable state regulatory agency.2
Originally, the plan was that loss of a dependent – or loss of dependent status – due to death, divorce, legal separation, or child support order was to become a qualifying event effective in January 2017 for people who were already enrolled in an exchange plan. But in May 2016, HHS reversed its position on this issue, stating that an SEP based on loss of dependent status or loss of a dependent even without an impact on coverage would remain optional for the exchanges, and exchanges were no longer required to offer this SEP starting in 2017.
So in most states, divorce, death, or legal separation doesn’t trigger an SEP unless there’s an associated loss of coverage.
Does the exchange in my state offer an SEP for loss of coverage due to death, divorce, or separation?
HealthCare.gov does not provide a special enrollment period for people who experience death or divorce without loss of coverage. HealthCare.gov’s policy manual notes that death or divorce/separation does not trigger a special enrollment period.1
But it’s important to note that people in these situations may simultaneously experience another qualifying life event that also triggers an SEP, regardless of whether they’re already enrolled in a plan through the exchange.
For example, a person who divorces and subsequently moves to a new location would be eligible for an SEP as a result of the move (assuming different health plans are available in the new area, and assuming the person already had coverage before the move). Similarly, a person who is covered as a spouse or dependent on an employer-sponsored plan would lose access to the plan if they got divorced or if the employee were to die. Even if up to 36 months of COBRA were to be available to that person, they would also have access to an SEP in the individual market, triggered by the loss of coverage.
In both of those examples, there’s no requirement that the person was already enrolled in a plan through the exchange; those special enrollment periods are more flexible than the one that would have been triggered by losing a dependent or no longer being considered a dependent.
(To clarify, the optional SEP for death or divorce is available to an “enrollee” which means a person already enrolled in the exchange. This differs from a “qualified individual” which means a person who is eligible to enroll in the exchange.3 The SEPs for a permanent move and for loss of coverage are both available to qualified individuals or enrollees whereas the optional SEP for death or divorce is only available to an enrollee.4 This is explained in more detail below.)
SEP limited to those already enrolled
For state-run exchanges that choose to offer an SEP triggered by losing a dependent or no longer being considered a dependent as a result of death, divorce, or legal separation, HHS has clarified that the special enrollment period is only available to people who are already enrolled in the exchange plan. (As noted above, this means an enrollee, as opposed to a qualified individual.)
This is in contrast to the special enrollment period triggered by birth, adoption, or marriage (gaining a dependent or gaining dependent status), which applies to the whole family, regardless of whether they were already enrolled in an exchange plan (in the case of marriage, at least one spouse must have been enrolled in minimum essential coverage prior to the marriage, but that doesn’t have to be an exchange plan).5.
But keep in mind that if the death, divorce, or separation results in a loss of coverage, the resulting SEP allows you to enroll in coverage both on- and off-exchange, and it applies regardless of where you obtained your prior coverage (eg, if a person is losing access to a soon-to-be ex-spouse’s employer-sponsored health plan due to a divorce, the person would be able to obtain coverage in the exchange or outside the exchange during the loss-of-coverage SEP).
State-run exchanges can still implement SEP
Some state-run exchanges have opted to implement an SEP due to death, divorce, or separation, even if the life event doesn’t result in loss of coverage. The ruling from HHS that made this SEP optional came less than seven months before the new SEP requirements were scheduled to take effect. So some exchanges had already done the work necessary to implement the new SEP and opted to go ahead with it, despite the guideline change from HHS.]
If you lose a dependent or lose dependent status as a result of a death, divorce, legal separation, or child support order, and you’re already enrolled in a plan through the exchange,6 check with the exchange to see if you’re eligible to make a plan change at that point. As mentioned above, you might be experiencing another qualifying life event at the same time, most of which apply even if you’re not already enrolled in a plan through the exchange.
As of 2024, the following state-run exchanges offer an SEP if an enrollee loses a dependent or loses dependent status due to death, divorce, or legal separation:
- California7
- Colorado8
- Washington DC9
- Maryland10
- New Mexico11
- New York12
- Pennsylvania13
- Rhode Island14
- Vermont 15
- Virginia16
- Washington17
How does the SEP work?
If a state-run exchange chooses to offer this SEP, here’s how it works:
In the case of death of an enrollee or dependent, the remaining enrollees on the QHP have 60 days from the date of death to enroll in a different plan. Coverage will be effective the first of the month following the new plan selection, or the first of the second following month, depending on the state and the effective date rules or deadlines that it uses (keeping in mind that this SEP is not available in any states that use HealthCare.gov unless the death or divorce result in a loss of coverage)..
In the case of divorce, legal separation, or child support order that causes the enrollee to lose a dependent or cease to be a dependent, the SEP runs for 60 days following the divorce, legal separation, or court order.
For now, the state-run exchange can choose to make coverage effective the first of the month following enrollment, or, if the application is submitted after the 15th of the month, the effective date can be pushed out to the beginning of the second month following enrollment (for example, an application submitted on June 16 could have coverage effective August 1 instead of July 1). But starting in 2025, all state-run exchanges will be required to make coverage effective the first of the month following enrollment, regardless of the date the application is submitted.18
In states that opt to implement an SEP triggered by loss of a dependent or loss of dependent status, the SEP is only applicable for people who are already enrolled in plans through the exchange, so it doesn’t give someone the right to purchase an off-exchange plan. And it doesn’t apply to people who are already enrolled in a plan obtained outside the exchange, or to people who are uninsured at the time of the death/divorce/separation.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “Federally-facilitated Exchange (FFE) Enrollment Manual” (page 68) Centers for Medicare & Medicaid Services. July 12, 2023 ⤶ ⤶
- “Update: Special Enrollment Periods Available to Consumers” Centers for Medicare & Medicaid Services. June 23, 2017 ⤶
- “45 CFR 155.20” Electronic Code of Federal Regulations. Accessed May 2, 2024 ⤶
- “45 CFR 155.420” Electronic Code of Federal Regulations. Accessed May 2, 2024 ⤶
- “45 CFR 155.420(d)(2)(i)(A)” Electronic Code of Federal Regulations. Accessed May 2, 2024 ⤶
- “45 CFR 155.420(d)(2)(ii)” Electronic Code of Federal Regulations. Accessed May 2, 2024 ⤶
- “Qualifying Life Events” Covered California. Accessed May 2, 2024 ⤶
- “Guidance: Special Enrollment Periods” Connect for Health Colorado, Accessed May 2, 2024 ⤶
- “Individual and Family Special Enrollment Periods” DC Health Link. Accessed May 2, 2024 ⤶
- “Frequently Asked Questions: Getting Coverage Outside Open Enrollment” Maryland Health Connection. Accessed May 2, 2024 ⤶
- “Who Can Enroll in a Plan with BeWell?” beWellnm. Accessed May 2, 2024 ⤶
- “Special Enrollment Periods” New York State of Health. Accessed May 2, 2024 ⤶
- “Special Enrollment Period Quick Reference Guide” Pennie. Accessed May 2, 2024 ⤶
- “HealthSource RI Policy Manual – 2023-2024” (Chapter 3) HealthSource RI. Accessed May 2, 2024 ⤶
- “Life Events Chart” Vermont Health Connect. Accessed May 2, 2024 ⤶
- “Qualifying Life Events and Special Enrollment Periods” Virginia Health Insurance Marketplace. Accessed May 2, 2024 ⤶
- “Special Enrollment” (losing a household member or dependent status) Washington Healthplanfinder. Accessed May 2, 2024 ⤶
- “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program” U.S. Department of the Treasury; U.S. Department of Health and Human Services. April 2, 2024 ⤶
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