Which of the following events would generally qualify an individual for a Special Enrollment Period (SEP) to enroll in a QHP outside the annual Open Enrollment Period?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
SEPs allow enrollment outside Open Enrollment when a qualifying life event occurs, most commonly loss of other minimum essential coverage, including employer coverage, COBRA exhaustion, or expiration of a student plan; changes in household such as marriage, birth, or adoption; or moving to a new coverage area. The SEP window is limited, and the applicant generally must enroll promptly after the event. A mere desire for coverage does not create an SEP. The SEP framework is event-driven: it exists so that people are not locked out of the market when they lose coverage or their family changes. Each qualifying event opens a 60-day window to enroll, and coverage generally begins on the first day of the month following enrollment, so acting within the window matters.
Why the other options are wrong
- D) An SEP requires a qualifying life event; a general desire for coverage is handled only through Open Enrollment. An SEP requires a qualifying life event; a bare decision that coverage is desired does not open a special enrollment window.
- A) A vacation move does not trigger an SEP; the move must be a change of residence to a new service area. Only a permanent move to a new coverage area creates an SEP; a temporary vacation relocation does not qualify.
- B) Turning 26 typically triggers loss of dependent coverage, which opens an SEP for the young adult; remaining on the parent's policy does not. Turning 26 typically ends dependent coverage and can start an SEP, whereas staying on the parent's policy creates no need to enroll and therefore no SEP.
Memory hook
SEP keys: lose coverage, gain family, or move home. Life changes open the enrollment window.