SEP Verification: Proof Before Coverage
Marriage, adoption, a move, coverage loss, or a Medicaid denial now gets checked up front.
Special Enrollment Periods get verified before coverage starts in 2027 — not after. The federal Marketplace must verify SEP eligibility for at least 75% of new SEP enrollments, and coverage does not take effect until verification completes.
The Five Verified SEPs
- Marriage
- Adoption
- Moving to a new coverage area
- Loss of minimum essential coverage
- Medicaid/CHIP denial
What Changes For Your Workflow
- Collect the proof document on the enrollment call — employer termination letter, marriage certificate, move paperwork — and upload it immediately.
- Set expectations: no verification, no start date. If the client can’t verify in time, the plan selection can be cancelled.
- The low-income monthly SEP (at or below 150% FPL) stays prohibited for 2027 — route those households to Medicaid/CHIP checks or Open Enrollment.
Questions about the 2027 rules?
Step 1: run the 60-second subsidy calculator first — see your likely lane, then come back and enroll.
I’m Christopher Horne, a licensed broker in FL, TX, AZ, OH, MI, IA, NC, OK, MO, SC, and TN. Agents: text me and compare notes before Open Enrollment. Clients: enroll through my link and I’m still your agent of record — and I review every enrollment the same day.
Enroll Online →Or book a free call / text 954-787-9118. Rules summarized here are general guidance, not legal advice — always confirm in official CMS and carrier sources.