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Special Enrollment Periods for complex issues

After the Open Enrollment Period ends, you can enroll in an insurance plan on or off the Marketplace only if you qualify for a Special Enrollment Period. You can qualify for an SEP if:

  • you have a qualifying life event like having a child, getting married, or losing qualifying health coverage; OR

  • you have a complex issue discussed on this page.

Learn more about common Special Enroll Periods

Complex cases that may qualify you for a Special Enrollment Period

Exceptional Circumstances

If you faced a serious medical condition or natural disaster that inhibited you from enrolling, you may qualify for an SEP. An unexpected hospitalization, temporary disability, incapacitation, or natural disaster such as an earthquake, massive flooding, or hurricane would qualify as an exceptional circumstance.

Enrollment or plan information errors on the Marketplace website

If you are subject to misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to assist you with your enrollment (such as an insurance company, insurance agent, Navigator, or certified application counselor) and it kept you from either enrolling in a plan, enrolling in the right plan, or getting the premium tax credit or cost-sharing reduction you were eligible for, you may qualify for an SEP.

You may have experienced an error message while completing your application that prevented you from enrolling in a plan or prevented your health insurance company from receiving your enrollment information. If you experienced a technical error during your application or enrollment process on the Marketplace or your state's Exchange, you may qualify for an SEP.

You may also qualify for an SEP if the wrong plan information was displayed on the Marketplace, or your state's Exchange, at the time you selected your insurance plan. This misinformation may be incorrect coverage information, incorrect cost-sharing information, incorrect provider network information, or incorrect prescription formulary information that led to choosing the wrong plan for you.

Previously lived in a state that didn't expand Medicaid and you become newly eligible for help paying for a Marketplace plan because your household income increased or you moved

If you previously lived in a state that did not expand the Medicaid program under the Affordable Care Act and you were not eligible for Medicaid or premium tax credits ("subsidy") because your household income was too high for Medicaid but too low for a subsidy and you are newly eligible for a subsidy because of an increase in your household income within the past 60 days, you may qualify for an SEP. Also, if you moved in the past 60 days and that move caused you to become newly eligible for a subsidy, you may qualify for an SEP.

Denied Medicaid or CHIP

If you applied for Medicaid or CHIP during Open Enrollment and your state Medicaid or CHIP agency denied your application after Open Enrollment ended, you may qualify for an SEP. You may qualify for this SEP regardless of whether your applied for Medicaid or CHIP through the Marketplace and your information was sent to your state's Medicaid or CHIP agency, OR your you applied through your state's Medicaid or CHIP agency directly.