Special Enrollment Periods for Health Insurance

Key takeaways

A Special Enrollment Period lets you sign up for or change a Marketplace plan outside the yearly Open Enrollment, after certain life events.
Depending on the type, you usually have 60 days before or 60 days after the event to enroll.
If you lose Medicaid or CHIP coverage, you have 90 days. You can enroll in Medicaid or CHIP any time of year.
If you miss the window, you generally cannot enroll until the next Open Enrollment, unless another event qualifies you.

The short answer

A Special Enrollment Period lets you sign up for health insurance outside the yearly Open Enrollment period after certain life events. HealthCare.gov lists losing health coverage, moving, getting married, having a baby and adopting a child among them. Depending on the type, you usually have 60 days before or 60 days after the event to enroll.

Events that can qualify

Losing qualifying health coverage, including when COBRA coverage ends.
Moving. Generally you must have had qualifying coverage for at least one day in the 60 days before the move.
Getting married. Generally one spouse must have had qualifying coverage for at least one day in the 60 days before the marriage.
Having a baby or adopting a child.

How the 60 days work

If you lost coverage, pick a plan within 60 days after the date it ended. If you lost Medicaid or the Children's Health Insurance Program (CHIP), you have 90 days.
If you will lose coverage, you can pick a plan up to 60 days before it ends.
You may be asked to send documents that confirm your event. Send them within 30 days of picking a plan.
If you already lost coverage, your new coverage starts on the first day of the month after you pick a plan.

Medicaid and CHIP are different

HealthCare.gov says you can enroll in Medicaid or CHIP at any time of year. Job-based plans must give a Special Enrollment Period of at least 30 days.

If you miss the window

If your Special Enrollment Period has passed, you can't enroll in a Marketplace plan until the next Open Enrollment, unless you qualify for another Special Enrollment Period. Marketplaces that states run can set their own enrollment dates, so check yours.

A short checklist

Write down the date of the event.
Check whether your event is on your marketplace's list of qualifying events.
Pick a plan before the deadline, which is usually 60 days.
Keep the documents that prove the event.

Common mistakes

Waiting until after the 60 days have passed.
Assuming that moving or getting married always qualifies. You generally need to have had qualifying coverage beforehand.
Forgetting that Medicaid and CHIP can be joined any time.

General information only. It is not insurance, legal or financial advice. Rules differ by state and change over time, so confirm details with your state insurance department, your insurer and your policy.

Questions

Does losing my job-based insurance qualify me?

Losing qualifying health coverage, including job-based coverage, can qualify you for a Special Enrollment Period. When COBRA coverage ends, you also have 60 days to enroll in a Marketplace plan.

Can I enroll just because I missed Open Enrollment?

No. Missing Open Enrollment is not a qualifying life event by itself. You generally need to wait for the next Open Enrollment unless a qualifying event applies.

Where do I apply?

Through the Marketplace: HealthCare.gov, or your state's marketplace if your state runs its own.

Sources

HealthCare.gov: Special Enrollment Period (glossary)healthcare.gov
HealthCare.gov: Getting health coverage outside Open Enrollmenthealthcare.gov
HealthCare.gov: Send documents to confirm a Special Enrollment Periodhealthcare.gov
CMS: Special enrollment periods available to consumers (PDF)cms.gov

Informational only. Rules and policy terms change and differ by state and insurer. Confirm details with your policy, your insurer or your state insurance department.