Special Enrollment

Outside of the open enrollment period, you can enroll in MDwise Marketplace only if you qualify for a special enrollment period. Most special enrollment periods last 60 days from the date of the qualifying life event. If you think you qualify for a special enrollment period, please call our customer service department at 855.417.5615. 

Qualifying life events that create a special enrollment period include:

  • Getting married.

  • Having, adopting or placement of a child.
  • Permanently moving to a new area that offers different health plan options. The consumer must have had minimum essential coverage within the last 60 days to qualify for a special enrollment period under this circumstance.
  • Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.
  • For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions. This exclusion is only available for individuals who purchased health insurance on the Federally Facilitated Marketplace.
  • Becoming newly eligible for Marketplace enrollment due to gaining status as a citizen, national, or lawfully present individual, or being released from incarceration.

You may also qualify for a special enrollment period if you have certain complex situations. Some cases and examples that may also give you a special enrollment period include:

  • Exceptional circumstanceYou faced a serious medical condition or natural disaster that kept you from enrolling. For example:
    • An unexpected hospitalization or temporary cognitive disability.
    • A natural disaster, such as an earthquake, massive flooding or hurricane.
    • A planned Marketplace system outage, such as Social Security Administration system outage.
  • Misinformation or misrepresentation–Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:
    • Not getting enrolled in a plan.
    • Being enrolled in the wrong plan.
    • Not getting the premium tax credit or cost-sharing reduction you were eligible for.
  • Enrollment error–Your application may have been rejected by the insurance company’s system because of errors in reading the data, or some of the data was missing or inaccurate.
  • System errors related to immigration status–An error in the processing of applications or system caused you to get an incorrect immigration eligibility result when you tried to apply for coverage.
  • Display errors on HealthCare.gov–Incorrect plan data was displayed at the time that you selected your health plan, such as benefit or cost-sharing information. This includes issues where some consumers were allowed to enroll in plans offered in a different area, or enroll in plans that don’t allow certain categories of family relationships to enroll together.
  • Medicaid/Marketplace transfers–
    • If you applied for Medicaid through your state or were sent to Medicaid from the Marketplace, but you weren’t eligible for Medicaid.
    • Your state transferred your information to the Marketplace but you didn’t get an answer about your eligibility and/or didn’t get enrolled before the end of the open enrollment period.
  • Error messages–Your application was stopped due to specific error messages. For example, you received a "data sources down" error message or another error message that didn’t allow you to enroll.
  • Unresolved casework–You’re working with a caseworker on an enrollment issue that didn’t get resolved before the end of the open enrollment period. 
  • Victims of domestic abuse–You’re a victim of domestic abuse and weren’t previously allowed to enroll and receive advance payments of the premium tax credit separately from your spouse. You’ll be able to do so now.
  • Other system errors–Other system errors that kept you from enrolling, as determined by the Centers for Medicare & Medicaid Services.

If you qualify for a special enrollment period

If you think you qualify for a special enrollment period, please call our customer service department at 855.417.5615. If you do not qualify for a special enrollment period, the next open enrollment period for 2018 coverage lasts from November 1, 2017 to January 31, 2018.