Major life events, or a change in household income, may change your eligibility for healthcare programs and financial help through Vermont Health Connect. For example, a major life event could mean that you:
- Are newly eligible for Medicaid or Dr. Dynasaur coverage
- Are newly eligible to get financial help, such as premium tax credits
- Can add new family members to your healthcare plan
- Have a change to the amount of financial help you can get
If you get financial help from Vermont Health Connect and you forget to report a change, you might end up owing money back to the federal government when you file taxes. That’s one reason why it’s important to report any major life changes to Vermont Health Connect within 30 days after the change happens.
If you’ve had a major life event, you may be eligible for a Special Enrollment Period (SEP) to enroll in Vermont Health Connect coverage. An SEP lets you sign up for coverage or change the plan you already have. This is the only time you can sign up for new coverage or change coverage outside of Vermont Health Connect’s Open Enrollment Period which typically runs from November 1-January 15 every year.
There are different types of SEPs. Each SEP has rules that you must meet to be eligible
- One type of SEP is ongoing. To get this SEP a customer must be eligible for financial help and have an income below 200% FPL. You must meet certain income rules. New or existing customers who meet the rule can sign up for coverage of change their health plan any time. For more information see the 2022 Eligibility Tables.
- For example, in 2022, if you are single with an annual income at or below $25,760, you might be eligible for this SEP. A couple with an income at or below $34,840 may be eligible, And a family of four with an income at or below $53,000 may also be eligible.
- Other types of SEPs may open to certain events. Some of these events include marriage, divorce, having or adopting a child or losing other health care. These SEPs have a time limit. You must enroll within 60 days of the qualifying event. So don’t delay! If you miss it, you may have to wait until Open Enrollment to get coverage.
For a detailed list of major life events and Special Enrollment periods, check out our qualifying events chart.
Medicaid and Dr. Dynasaur enrollment continues year-round. Vermonters who are eligible for these programs can enroll at any time. If you are enrolled in Medicaid you must report any changes within ten days.
In addition to our standard qualifying events, special enrollment periods can be granted under additional exceptional circumstances. Vermonters should apply for the Exceptional Circumstance SEP only if an event such as a medical issue, natural disaster, or a system interruption prevented them from enrolling in a QHP during their enrollment period (like Open Enrollment or a Special Enrollment Period). Below are some examples:
A Vermonter qualified for a Special Enrollment Period that expired March 31st. This person was in the hospital from March 14th to April 1st and was too sick to enroll in a QHP at that time. This person may be eligible for the Exceptional Circumstance SEP. They should complete the Exceptional Circumstances application, as well as the medical incapacity verification form.
A Vermonter qualified for a Special Enrollment Period that expired May 31st. This person got sick in July after their original SEP expired and now needs health coverage. This person was not sick during their original Special Enrollment Period and was not prevented from enrolling prior to May 31st. Therefore, this person would not qualify for the Exceptional Circumstance SEP.
Apply for an Exceptional Circumstances SEP here. If you have a question about an exceptional circumstance, or need to change an existing application, please call 1-855-899-9600.