WorksheetsSpecial Enrollment Period
Total questions: 25
Worksheet time: 50mins
Debbie missed Open Enrollment and applied for Medicaid but was denied, are they eligible for special enrollment?
Not enough information
No, they had to have applied during OE or during a QLE and then been denied
Yes, being denied Medicaid is a life event
Steve cancelled his COBRA because he is no longer able to afford it, can he qualify for a special enrollment?
No, because cancelling a plan is not a valid event
Yes, because COBRA is expensive
No, because you can't cancel it, it only expires on its own
Yes, because COBRA is not a QHP
Carols employer stopped contributing towards their COBRA premium, is that a QLE?
Yes, the change in assistance makes them eligible
No, once you elect COBRA you are stuck with it
Charlamagne was receiving a subsidy but had an increase in income above 400% FPL and lost their subsidy. Are they eligible to change their plan?
Yes, but they will have to stay in the same metal level
Yes, and they can choose any plan
No, they must stay in the same plan
Not enough information to answer
Santiago made a permenant move to the U.S. from Italy. What documentation is needed to verify their QLE?
I-94, proof of entry
Proof of insurance
Income Documents
Incarceration status
Karen went to Spain for 3 months where she had scheduled a hip replacement and has recently returned to the U.S. She is now inquiring about obtaining health insurance through a special enrollment since she moved back to the U.S. from a foreign country.
Karen did not make a permanent move & moving for medical treatment is not a valid reason, Karen is not eligible for an SEP
Karen's previous insurance worked in a foreign country, therefore she cannot apply for new coverage
Karen has a QLE, since she left the US and then came back within one year
There is not enough information to determine her QLE status
Marriage is a qualifying life event as long as _____
Both spouse's held insurance for at least one day in the last 60 days
They have no children
At least one spouse carried insurance for at least one day in the 60 days before their marriage
They have a home together and live at the same address
Mike is losing short term disability insurance and moving to long term disability. Does Mike have a qualifying life event?
Yes
No
Is being pregnant a qualifying life event? Why?
No, only having the baby is
Yes, it's the biggest life event to ever happen in someones life
Jack is losing workman's comp insurance, can they enroll in coverage during special enrollment?
No, it is not considered a qualified health plan
Yes, losing insurance is a life event
Can someone experience a qualifying life event during open enrollment?
Yes, but they will need to complete 2 applications
No, they can only enroll for Jan of the next year
Fatima just received their A- number but their immigration status has not changed and are waiting for approval. Are they eligible to enroll for special enrollment?
Yes, but they may not qualify for a subsidy
No, a date of approval is required in order to complete an application
Yes, as long as they have the A number the immigration status does not matter
No, they must be a resident or citizen
What questions would you ask to find out more about someone's life event to determine if it is qualifying or not? (select all that apply)
When their life event happened
Do nothing, the consumer will tell you everything you need tok know
Why they lost insurance & Where they got their insurance from
Who experienced the event
Is developing cancer or medical condition a qualifying life event? Why?
Yes, especially cancer or infusions
No, anything medical related is not considered a QLE
No, it has to be terminal
Carla calls in because they received a notice that the family lost Medicaid. When asked for the reason, she said it was due to documentation not being sent in. What can we tell Carla?
Their loss of coverage is a life event which will allow them to apply within 60 days of the date on the letter
They may still eligible for Medicaid and need to follow up with Medicaid to either reapply and provide documents or be denied officially
Do you have to prove insurance coverage if you move to the US from a foreign country? Why?
Yes, they need to prove it or it is not qualified
No, because almost every country has universal healthcare
Dave calls in because his short term policy through Freedom Life is ending. It was an inferior plan that focused on emergency coverage and based on his current needs, he is now looking for something with a bit more coverage. What can we tell Dave?
Because a short term plan is not a qualified health plan he will not be eligible to apply until Open Enrollment
Losing insurance, as long as it covered emergencies, is a qualifying event to enroll now
There is not enough information
What challenges may arise when helping someone who was recently released from incarceration?
Having a permanent home address
Meeting income requirements
Being rude to us
Their level of understanding of the ACA
Months before their divorce was finalized, Jared dropped Eric from his employer coverage. Can Eric, who called within 60 days, apply with a special enrollment?
Yes, but they may not qualify for a subsidy if the divorce doesn't occur within the benefit year
No, they must be divorced
Yes and they can file single for the subsidy
Not enough information
Cynthia calls from prison, they will be released in 2 weeks and want to get coverage for when they are released, will they qualify?
No, Cynthia cannot apply until after they are released, but we can run a quote and give them information
Yes, they get up to 60 days before release to apply and it's always good to be prepared
No, they have to wait until open enrollment
Yes, they will even get a subsidy
Why is there a special enrollment instead of year round open enrollment?
What are some examples of documents a consumer can use to verify their move? (select all that apply)
Proof of insurance and USPS address change document
Lease / mortgage agreement
Previous address
New utility bill
Can you apply for coverage before you move?
No, you can only apply after the move
Yes, as long as you have the address where you will be moving
Depends, if you have done the address change already you can apply using that date
No, a move is not a life event
Which states considers becoming pregnant a qualifying life event?
NY, DC, MD
KY, VA, VT
ID, IL, NV
NC, RI, MA
If a consumer elected COBRA but only for one month, when can they apply for Marketplace? (select all that apply)
After 18 months
Within their 60 day window from losing employer coverage
During Open Enrollment
After they run out of money to pay for it
