If someone loses access to MassHealth coverage, it is considered a loss of coverage and a Qualifying Life Event that triggers a Special Enrollment Period (SEP) for Health Connector Coverage.

A SEP means that someone can enroll in or change health insurance plans outside the annual Open Enrollment period. Beginning on 4/1, anyone who receives a SEP for any qualifying life event will have their enrollment window extended to 11/23. Other life events that let someone qualify may include:

• Changes in household make-up, income, immigration status, or address.
• Certain other life changes, like getting married, having a baby, or losing job-based health insurance.

Applicants Must:  

Report any life changes that would impact their eligibility, like starting or ending a job, within 30 days of it occurring. Many life changes result in someone qualifying for a SEP. Payment and enrollment deadlines still apply during a Special Enrollment Period.

How Will this Work in the Online Application?

The online application will automatically open some SEPs, if reported eligibility changes result in a qualifying life event (for example, if the member is redetermined out of MassHealth and newly qualifies for Health Connector coverage).

If a qualifying life event was not reported in the online application, individuals can use the “Can I Shop?” button to complete a questionnaire to determine if they have experienced a qualifying life event.

When an applicant is in their online application, the SEP questionnaire screens will work as it currently does, but with an extended enrollment window.

• Assisters and anyone helping an applicant should note that this will not display immediately, but the extension date will appear in the person’s application the following day.

The Health Connector will continue to mail members SEP decision notices, and we will request proof as needed.

Join the Health Connector and MassHealth in April for the MA Health Care Learning Series webinars to learn more about the SEP and to review some common member scenarios that you may encounter. To sign up for these sessions go to the MTF registration page and select your preferred date.