Chapter 4: Special Enrollment Guide

How your ‘big move’ can trigger an SEP

A permanent move – even if it's not out of state – can trigger a special enrollment period. Here's when the SEP applies, and when it doesn't.

The Insider's Guide to Obamacare's Special EnrollmentA permanent move to a new area will generally trigger a special enrollment period (SEP) for people who already coverage prior to their move. As long as there are different health plans (QHPs) available in the new area, the SEP will apply. This is true even if your current plan is still available in the new area.

If you move to a new state, you’ll definitely have an SEP, since each state has its own exchange with unique plan offerings. If you move to a new location within the same state, you might have an SEP; it will depend on whether the QHPs available in the new area are the same as the ones that were available in your old area. Most states have some carriers that offer plans state-wide and others that are more localized, so the availability of an SEP will vary depending on plan availability in your old and new locations.

The SEP triggered by a permanent move also applies on or off-exchange, so you have a choice of where you get your new plan. (Make sure you buy your plan through the exchange if you qualify for subsidies, as they’re not available off-exchange.)

When the SEP applies, and when it doesn’t

As of July 11, 2016, the SEP triggered by a permanent move only applies if you already had coverage prior to your move (defined as having minimum essential coverage for at least one of the 60 days preceding the move). You cannot be uninsured, move to a new area, and enroll in a health plan as a result of the move (there are exceptions to the requirement that applicants be insured prior to the move in three circumstances: people who are newly released from incarceration, moving back to the US after living abroad, or previously in the coverage gap in a state that has not expanded Medicaid. In all of these circumstances, the person did not have the opportunity to have minimum essential coverage in place prior to the move, which is why they still qualify for a SEP when they move, regardless of their prior coverage or lack thereof).

In 2016, HHS released additional guidance on this SEP, noting that the move must be considered permanent, and that the individual must “intend to reside” in the new location and “intend to remain” there. But there’s also quite a bit of flexibility for people who move frequently, such a seasonal workers, students, and early retirees.

HHS has clarified that the SEP for a permanent move applies to individuals who are newly released from incarceration. It also applies to people moving to or from a shelter, to seasonal workers moving to or from the place where they work seasonally, and to students moving to or from the location where they attend school. The SEP also applies if you’ve been living abroad and move back to the United States.

The SEP does not apply if you’re moving to an inpatient hospital or treatment facility in another area for the purpose of receiving medical or behavioral health treatment.

What about people with more than one residence?

A person who has homes in more than one location can establish residency in both places, and is allowed to switch back and forth between QHPs in each area. HHS notes that brief trips away from one’s primary home do not count as establishing residency elsewhere, but spending “an entire season or other long period of time” at a second residence would make the person eligible to establish residency in the second location and enroll in a new QHP while living there.

This scenario might apply to an early retiree – not yet eligible for Medicare – who lives half the year in one state, and half in another. The best option in this case might be a single plan with a nationwide network that the enrollee can maintain year-round in order to have a single out-of-pocket maximum that applies for the full year.

But such plans are not available in all areas, and enrollees might find that the plan they have in one state doesn’t offer out-of-network coverage and provides little value at their second home. The option to switch to a different plan with each move is thus valuable, although enrollees should be aware that each plan change will reset their annual out-of-pocket costs back to zero.

How does the SEP work?

You have 60 days from the date of your move to enroll in a new plan, on or off-exchange. The exchange has the option of providing coverage effective the first of the month after you enroll, or following the regular effective date guidelines. In most states, that means enrollments completed by the 15th of the month will result in coverage effective the first of the following month.

Exchanges have the option of offering the SEP for a permanent move in advance of the move. This was intended to become mandatory as of January 2017, but HHS reversed course in 2016, keeping the advance access to the SEP optional at the discretion of the exchange.

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