Blue Buzz: What's so Special About Special Enrollment Periods?

Life happens. One minute we’re in our groove. The next minute, we’re reacting to big new information that we didn’t see coming. Whether good or bad – plan or unplanned – these life-changing events can pose a challenge to how we access health care. This might trigger an opportunity for you to participate in a Special Enrollment Period, which allows you enroll in a health plan or change the health care coverage you currently have.

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Show Transcript

Life happens one minute. We're in our groove. The next minute, we're reacting to big new information that we didn't see coming, whether good or bad planned or unplanned, these life-changing events can pose a challenge to how we access health care. And they might trigger an opportunity for you to enroll in a health plan or change the health care coverage you currently have. Meet Casey. Casey is a daycare employee, who's new to Austin. She grew up in El Paso and really has a heart for kids. Now, having an hourly job is tough, but she's smart with her money. She chose a health care plan through the Health Insurance Marketplace, and it's been a good fit for her...till now. With their wedding coming up in a few weeks, Casey and her fiancé are going to need a different kind of coverage. Lucky for them, they qualify for a special enrollment period.

Everyone with health insurance coverage gets some kind of opportunity to change their coverage after big life events. However, I'm talking specifically about special enrollment for people who get individual policies from the health care marketplace. So what makes special enrollment so special? Well, you do. It's based on the special things happening in your life. These are called qualifying events. For example, did you get married recently? Congrats! You and your spouse can enroll in a new health plan.
Or maybe you welcomed a new baby into the family. Or perhaps you're dealing with more of a somber situation like a divorce or the loss of a family member. If You were depending on that person for healthcare coverage, then you could be eligible for a special enrollment period. Now, perhaps you've had a major move where your income has changed, or maybe you're adulting on your own. Now, if you've aged out of your coverage under your parents, then you have a special opportunity to enroll.

Sometimes life gets a little crazy for everyone like during the COVID-19 pandemic. It posed what we call an "exceptional circumstance."
And in situations like this, the President of the United States can sign an executive order to launch a special enrollment period for everyone. In this instance, you don't need that special qualifying life event to change your coverage in a way it's like the pandemic itself is the qualifying event. It's for the greater good, so when it happens, you might just want to take advantage. Special enrollment periods are also a great opportunity to see if you're eligible for financial help from the Marketplace. Also known as a subsidy or tax credit. Paying less for coverage each month could really be helpful in times of hardship. And the good news is healthcare coverage could be more affordable than you think. Under the American Rescue Plan Act expanded subsidies will allow some Texas to pay as low as $0 per month for some health plans. In 2020 subsidies helped 92% of Texans lower their monthly bill. Check out this example, Brian and Susanna live in Dallas County. They're both 40 years old and neither of them smoke. Now, together their annual income falls below $44,000. They want coverage under the trusted brand of Blue Cross and Blue Shield of Texas so they signed up for MyBlue Health Plan. The monthly price they pay? After subsidies, nothing. Not a dime. Remember Casey? She was thrilled with the subsidy that she got for her and her new husband, even with their combined incomes, they both still qualified for a subsidy. And when you sign up, you'll also learn if you're qualified for Medicaid. While you're shopping, take some time to really explore your options. Determine if the plan has the right benefits and is a good fit for your monthly budget. Pay attention to out-of-pocket costs like deductibles co-pays and co-insurance. Also make sure your medications will still be covered and that your doctor is included in your new network. You may also want to plan with 24/7 tele-health services. Some plans even offer discounts on gym memberships and financial incentives when you take the initiative to be healthy. Consider adding additional coverage, dental vision accident, or critical illness. Insurance are all affordable options that can protect your family from head to toe. Need help applying? Blue Cross and Blue Shield of Texas can answer your questions. Reach out to them for assistance in English or Spanish, and they'll help you find a health plan. That's right for you and your family. Keep in mind, there's a window of time that applies to a special enrollment period. So you need to act quickly. There are also some other nuances too, so be sure to check them out at bcbstx.com/SEP or healthcare.gov. At first, health care can seem rigid, but it's actually designed to be flexible. So remember, major life changes can be an opportunity for your healthcare to adapt to you.

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