Open Enrollment is your window each year to enroll in health insurance or change your plans. You definitely do not want to miss this opportunity to secure an insurance policy for the next year. However, sometimes life happens, you procrastinate a little bit too long, or you simply just forgot to enroll in a plan and now Open Enrollment has ended. The good news is you can still get coverage but your options may be limited.
The Affordable Care Act (ACA) allows for Special Enrollment Periods if you have a qualifying event. You can also enroll in short term, limited medical, gap plans, Medicaid, CHIP, and cost-sharing ministry programs anytime throughout the year if you qualify for those plans. Let's take a deeper look into these options.
Special Enrollment Periods
A Special Enrollment Period (or SEP) is a time outside of open enrollment when you are able to enroll in a health insurance plan. To be eligible to an SEP, you'll need to have a qualifying life event that meets the ACA requirements for SEPs and typically must have had previous qualifying insurance coverage (also called Minimum Essential Coverage) although some qualifying events do not require this. If you have a qualifying life event, you are typically granted a 60-day window starting from the date of the qualifying event.
You can prepare ahead of time if you know a qualifying event will be coming within the next 60 days. In most cases, you can enroll up to 60 days before the event allowing your coverage to start on the qualifying event date and avoiding any lapse in coverage.
Tip from the Pros: You will likely have to prove that you had a qualifying event when applying for an SEP. Make sure you keep any documents verifying your life event as these will have to be submitted to the Marketplace (or your state's Exchange) for verification.
Changes in my household size
You may qualify for a SEP if you or anyone in your household experiences one of the following in the past 60 days:
I'm getting married. Do my new spouse and I qualify for a SEP?
Yes. You can enroll in an insurance plan up to 60 days after the date you got married. If you choose a plan by the last day of the month, your coverage can start the first day of the following month.
I'm getting divorced or legally separated and lost my health insurance. Can I enroll in a plan?
Yes. You would have 60 days from the date of separation or a final divorce judgment is issued to enroll in a plan. IMPORTANT: Divorce or separation without losing health coverage does not qualify for a SEP. You must have qualifying coverage prior to the divorce or separation and have lost that coverage due to the divorce or separation.
I'm having a baby, adopting a child, or placing a child for foster care. Is there a SEP for that?
Yes. You get a 60 day SEP to enroll in a plan starting from the date of the event. Your coverage can start on the day of the event even if you enroll 60 days after.
I experienced a death in my family and lost my health insurance. Is there a SEP for me?
Yes. You are eligible for a SEP to enroll in a plan for up to 60 days following the date of death. IMPORTANT: Experiencing a death without losing qualifying health coverage as a result of the death does not qualify for a SEP. You must have qualifying coverage prior to the death and have lost that coverage due to the death.
Changes in my residence
Household moves that qualify you for an SEP:
I'm moving to a new home and changing my ZIP code or county. Can I get a SEP?
Yes. If you are moving your permanent residence to a new ZIP code or county you may qualify for a SEP for 60 days following the date of your move. NOTE: Moving only for medical treatment or staying somewhere for vacation does not qualify you for a SEP.
I'm moving to the U.S. from a foreign country or U.S. Territory. Is there a SEP for this?
Yes. You may get a 60 day SEP to enroll in a health plan following the date you move to the U.S.
I am a student moving to or from the place I attend school. Can I enroll in a plan?
Yes. You have 60 days from the date you move to or from the place you attend school to enroll in a health plan.
I'm a seasonal worker moving to or from the place I live and work. Do I get to enroll in a plan?
Yes. As long as you are moving to or from the place where you live and work seasonally, you may qualify for a SEP for 60 days to enroll in a new plan.
I am moving to or from a shelter or other transitional housing. Is there a SEP for this?
Yes. When you move into or out of a shelter or transitional housing, you may have 60 days to choose a health insurance plan.
IMPORTANT: When qualifying for an SEP due to any change in residence, you must prove you had qualifying health coverage for one or more days during the 60 days immediately preceding the date you moved. You don't need to provide proof if you are moving from a foreign country or U.S. Territory.
Loss of qualifying health insurance
You may qualify for a SEP if you or anyone in your household lost qualifying health coverage in the past 60 days OR expect to lose coverage in the next 60 days.
I lost my health insurance through my employer. Can I choose a new plan?
Yes. You may qualify for an SEP for 60 days if you or anyone in your household lost qualifying coverage that was provided by a current or previous employer. This includes dependents that lose coverage through a parent or guardian because they are no longer a dependent. IMPORTANT: Losing coverage due to voluntarily dropping the employer's coverage does not qualify you for an SEP. You also do not qualify if you lose coverage because you didn't pay your premium.
I received a notice from my insurance company that I am losing the individual health coverage I bought myself. Do I qualify for an SEP to choose a new plan?
Yes. You may qualify for a 60 day SEP if you lose your individual coverage because your Marketplace plan is discontinued, you lose eligibility for your student health plan, you lose eligibility for a plan because you no longer live in that plan's service area, or your individual or group health plan year is ending in the middle of the calendar year and you choose not to renew it. IMPORTANT: Losing your individual coverage because you voluntarily drop it, didn't pay your premiums, or failed to provide required documentation when the Marketplace asked for more information does not qualify you for an SEP.
I received a notice from my state's Medicaid or CHIP administration office that I am losing eligibility for Medicaid or CHIP. Can I get an SEP to enroll in a health plan?
Yes. You may qualify for an SEP lasting 60 days if you lose Medicaid or Children's Health Insurance Program (CHIP) because you experienced a change in household income making you ineligible for Medicaid or your child ages off CHIP.
I received a notice that I am losing eligibility for Medicare. Is there a SEP for this?
Yes. You may be eligible for an SEP for 60 days after you lose eligibility for premium-free Medicare Part A. IMPORTANT: You do not qualify for an SEP if you lose Medicare Part A because you didn't pay your Medicare premium or you lose Medicare Parts B, C, or D only.
I'm losing coverage through a family member. Can I get an SEP to enroll in my own plan?
Yes. You may qualify for an SEP lasting up to 60 days after you lose coverage through a parent, spouse, or other family member if you turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent's health plan, you lose coverage through a family member's employer because that family member loses health coverage or coverage for dependents, you lose coverage through a spouse's employer due to a divorce or separation, you lose coverage due to the death of a family member, or you lose coverage through a parent or guardian because you are no longer a dependent. IMPORTANT: Losing coverage as a dependent of a family member due to voluntarily dropping the coverage does not qualify you for an SEP. You also don't qualify if you lose coverage because you didn't pay your premium.
More qualifying changes
Other life circumstances that may qualify you for an SEP are:
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder
Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
AmeriCorps State and National, VISTA, and NCCC members starting or ending their service
What if I have a complex issue?
Sometimes things go awry, and the ACA planned for this. There are some complicated cases that may qualify for an SEP:
Experience an exceptional circumstance
Experience a Marketplace enrollment or plan information error
You live or previously lived in a state that hasn't expanded Medicaid and you become newly eligible for help paying for a Marketplace insurance plan because of an increase in household income or move
Be determined ineligible for Medicaid or CHIP
Gain or become a dependent due to a child support or other court order
Experience domestic abuse/violence or spousal abandonment
Get an appeal decision in your favor