More than 10 Million Uninsured Could Obtain Marketplace Coverage through Special Enrollment Periods

Special enrollment periods (SEPs) let eligible consumers remain seamlessly insured when undergoing a life-changing event like a marriage, a job loss or Medicaid termination due to increased income, among others.

The Issue
Researchers estimate 33.5 million people every year experience a life-changing event that ends their health insurance coverage making them eligible to enroll in marketplace plans outside standard open enrollment periods.

Key Findings

  • The most frequent trigger of SEP eligibility is job loss that ends employer-sponsored insurance.

  • The second-most common SEP involves consumers whose increased income terminates their Medicaid eligibility.

  • Based on data through June 2015, fewer than 15 percent of the uninsured who qualify for SEPs will use them to enroll in marketplace plans.

The authors suggest that both consumers and marketplaces could benefit if and state marketplaces developed application assistance and enrollment campaigns that focus specifically on life events that trigger SEPs.

About the grantee
The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.