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

Probably not, as 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. Also, to qualify for a special enrollment based on a permanent move, you must have had health insurance coverage for at least one day in the 60 days prior to your move.

Note however that you could qualify for a special enrollment period for other reasons, such as if your household income does not exceed 150 percent of the federal poverty level. You can contact the marketplace to see if you qualify. (45 C.F.R. § 155.420; CMS, FAQs on Marketplace Residency Requirement and Special Enrollment due to a Permanent Move, Jan. 19, 2016; Special Enrollment Periods (SEPs) Information).

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