Consumers who experience a qualifying life event can enroll in a Covered California health insurance plan even outside of the open-enrollment period. This is called special enrollment. If you qualify, you can enroll in Medi-Cal year-round. Below is a list of common qualifying life events for special enrollment that apply year-round.
Losing health coverage. For example: consumers who no longer qualify for Medi-Cal, or who lose health coverage through their job or spouse’s job.
Income changes so much that a current Covered California enrollee becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.
Turning 26 years old and no longer being eligible to stay on a parent’s plan.
Moving. For example: moving to California from another state or moving to a new region within California that allows a current consumer to gain access to new Covered California health insurance plans. This also applies to individuals who are released from jail or prison.
- Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
- Getting married or entering into a domestic partnership.
- Becoming a citizen, a national or becoming lawfully present (where the individual was not previously lawfully present).
- Being a member of a federally recognized American Indian or Alaska Native tribe. A consumer in this category may enroll in health insurance or change health insurance plan once a month, even if the open-enrollment period is over.
- Covered California can also determine, on a case-by-case basis, that the consumer experienced an exceptional circumstance, which could allow for a special-enrollment period.
These are just some of the more common qualifying life events. Consumers can click here to read more about special enrollment and qualifying life events. To apply for coverage through special enrollment, click here.
Due Dates to Enroll after a Qualifying Life Event
Consumers have 60 days from the date on which the qualifying life event happens to enroll in a Covered California health insurance plan or change their existing Covered California plan. For example, if a consumer has a child on June 1, they have until July 31 to notify Covered California, complete an application for their new child, choose a health plan and pay for it. If they do not get health coverage for their child, they may have to pay a tax penalty.
If 60 days pass and consumers do not sign up for health coverage, they will have to wait until the next open-enrollment period unless they experience another qualifying life event.
How to Enroll After a Qualifying Life Event
For many qualifying life events, consumers can enroll online. They can also call the Covered California Service Center at (800) 300-1506. Service Center representatives can answer any questions consumers have about a qualifying life event and can help them enroll in or change health insurance plans. Consumers can also find help from a Covered California Certified Enrollment Counselor, Covered California Certified Insurance Agent, Certified Plan Based Enroller, or county eligibility worker.
Notice Requesting Documents to Verify Your Qualifying Life Event
Some consumers who apply for Covered California coverage in a special-enrollment period are asked to submit verification of their qualifying life event. If you receive a letter asking you to submit documents for your qualifying life event, check the Special Enrollment Acceptable Document List to select the right document to send to us. If you cannot locate an acceptable document, you may submit a special enrollment period attestation form to Covered California. Click here for instructions on how to submit your document or attestation form.
Avoiding Gaps in Coverage
Consumers will need to plan ahead to avoid gaps in health coverage. It helps to know that in general, the start date for coverage depends on the date of enrollment. If consumers enroll by the 15th day of the month, coverage will start on the first day of the next month. If consumers enroll after the 15th day of the month, coverage will start on the first day of the second month. For example, if consumers enroll on June 13, their coverage will start on July 1. If they enroll on June 16, their coverage will start August 1. Consumers can use this rule as a guideline to help plan their new coverage and avoid gaps.
Start Dates for Coverage
For most qualifying life events, the start date for coverage depends on the date that consumers enroll, as discussed above. If consumers enroll by the 15th day of the month, their coverage will start on the first day of the next month. If consumers enroll after the 15th day of the month, their coverage will start on the first day of the second month.
But there are a few exceptions to the regular start date rule:
- For loss of health coverage, such as losing Medi-Cal coverage, or job-based coverage, their new health plan would start on the first day of the next month following enrollment.
- A consumer gets married and uses a special-enrollment period, their new health plan would start on the first day of the next month following enrollment.
- A consumer has a child, adopts a child or places a child in adoption or foster care, and they use a special enrollment period, their coverage starts on the date of the birth, the adoption or the placement for adoption or foster care or on the first day of the next month following enrollment, at the consumer’s option.
Signing Up for Medi-Cal Coverage
Consumers can sign up for Medi-Cal at any time. They do not need a special enrollment period to sign up for Medi-Cal. To find out if they or someone in their family is eligible for Medi-Cal, complete the online application by clicking “Apply” or by calling the county human services office.