QUESTION

I have been diagnosed with a serious health condition and will be obtaining care from an out-of-state hospital. During my course of treatment I’ll be living near the hospital. Can I qualify for a special enrollment period based on this temporary “move”?

Individuals with no coverage | Open and Special Enrollment Periods
ANSWER

No, you do not meet the marketplace residency requirements for the permanent move special enrollment. In your case, you are a temporary resident and you do not intend to live in the state where you’re receiving treatment. Further, the residency requirements for marketplace eligibility are not met in this circumstance. Also, to qualify for a special enrollment based on moving, you must have had health insurance coverage for at least one day in the 60 days prior to your move. (45 C.F.R. § 155.420; 82 Fed. Reg. 18346, April 18, 2017; CMS, FAQs on Marketplace Residency Requirement and Special Enrollment due to a Permanent Move, Jan. 19, 2016; Special Enrollment Period (SEP) Overview for the Federally-facilitated (sic) Marketplace, July 2018).

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