CACs Special Enrollment Periods and Life Events 1 — Questions and Answers
Question 1: How many days does a consumer typically have to enroll in a Marketplace plan after a qualifying life event triggers a Special Enrollment Period (SEP)?
- 30 days
- 60 days (Correct answer)
- 90 days
- 120 days
Correct answer: 60 days
Most qualifying life events grant a 60-day Special Enrollment Period window to select a Marketplace plan.
Question 2: Which of the following is a qualifying life event that triggers a Special Enrollment Period?
- Moving to a new apartment in the same ZIP code
- Losing job-based health coverage (Correct answer)
- Voluntarily canceling a previous plan
- Failing to pay monthly premiums
Correct answer: Losing job-based health coverage
Losing job-based health coverage is a qualifying life event that triggers a SEP, allowing enrollment outside Open Enrollment.
Question 3: A consumer moves from Texas to California. Does this qualify them for a Special Enrollment Period?
- No, moving within the US never triggers a SEP
- Yes, moving to a new coverage area is a qualifying life event (Correct answer)
- Only if they had no prior insurance
- Only if they are over age 65
Correct answer: Yes, moving to a new coverage area is a qualifying life event
Moving to a new coverage area where different Marketplace plans are available is a qualifying life event that triggers a SEP.
Question 4: What happens if a consumer misses the 60-day Special Enrollment Period window after a qualifying life event?
- They can still enroll with a late fee
- They must wait until the next Open Enrollment Period (Correct answer)
- They are automatically enrolled in Medicaid
- CMS grants an automatic 30-day extension
Correct answer: They must wait until the next Open Enrollment Period
Missing the SEP window generally requires the consumer to wait until the next Open Enrollment Period to enroll in a Marketplace plan.
Question 5: Which of the following is NOT a qualifying life event for a Special Enrollment Period?
- Getting married
- Having a baby
- Turning 30 years old (Correct answer)
- Losing Medicaid eligibility
Correct answer: Turning 30 years old
Turning 30 is not a qualifying life event, though turning 26 and aging off a parent's plan does trigger a SEP.
Question 6: A consumer gains a new dependent through adoption. Which SEP rule applies?
- They have 30 days from the adoption date
- They have 60 days from the adoption date (Correct answer)
- No SEP applies; they must wait for Open Enrollment
- They must report it within 10 days to CMS
Correct answer: They have 60 days from the adoption date
Adding a dependent through adoption is a qualifying life event that opens a 60-day Special Enrollment Period.
CACs Special Enrollment Periods and Life Events 1
How many days does a consumer typically have to enroll in a Marketplace plan after a qualifying life event triggers a Special Enrollment Period (SEP)?