Open enrollment is the main window for buying an individual health plan, but life does not wait for November. If you lose a job, get married, have a baby, or move, you may qualify for a Special Enrollment Period (SEP) that lets you enroll in or change a Marketplace plan during the year. This guide lists the qualifying life events, explains the deadlines, and tells you which documents to have ready so your enrollment goes through the first time.
Key takeaways
- A qualifying life event opens a Special Enrollment Period, usually 60 days long, to enroll in or change a Marketplace plan.
- Common events include losing other coverage, moving, marriage, birth or adoption, and changes in citizenship or immigration status.
- Voluntarily dropping coverage or losing it for non-payment does not qualify.
- The Marketplace may ask for documents to prove the event. Upload them right away.
- Employer plans and Medicare have their own special enrollment rules with different deadlines.
What a Special Enrollment Period is
The Marketplace limits enrollment to open enrollment each year so that people cannot wait until they are sick to buy coverage. A Special Enrollment Period is the exception. When a specific event changes your situation, you get a limited window to act.
Two things must be true:
- You experienced a qualifying life event.
- You apply within the deadline, which is generally 60 days from the event for Marketplace plans.
If both are true, you can enroll in a plan or switch plans, and you can be screened for premium tax credits at the same time. If you already have a Marketplace plan and report a change, your options to switch may be limited to plans in the same metal tier, depending on the event.
Qualifying life events, grouped by type
Losing health coverage
This is the most common reason people qualify. It includes losing:
- Job-based coverage because you left a job, lost a job, or your hours were cut
- Coverage as a dependent because you turned 26
- Coverage because of divorce, legal separation, or the death of the policyholder
- COBRA because it ran out (not because you stopped paying)
- Medicaid or CHIP because you no longer qualify
- Individual coverage because the plan was discontinued or you moved out of its area
- Student health coverage
For coverage loss, you can apply up to 60 days before the end date and up to 60 days after. Applying before the loss is the best way to avoid a gap. If you lost a job, see health insurance after losing your job for a full comparison of your options.
Changes in household
- Getting married
- Having a baby, adopting a child, or having a child placed for foster care
- Divorce or legal separation that causes you to lose coverage
- Death of someone on your plan that causes you to lose coverage
Note that divorce by itself does not qualify. It has to result in a loss of coverage.
Changes in residence
- Moving to a new ZIP code or county
- Moving to the United States from another country or a U.S. territory
- A student moving to or from the place they attend school
- A seasonal worker moving to or from the place they live and work
- Moving to or from a shelter or other transitional housing
For most moves, you must have had qualifying coverage for at least one day in the 60 days before the move. Moving for medical treatment or a vacation does not count.
Other qualifying events
- Becoming a U.S. citizen or gaining lawful presence
- Being released from incarceration
- Becoming a member of a federally recognized tribe or an Alaska Native Claims Settlement Act shareholder (members can enroll or change plans once a month)
- Starting or ending service as an AmeriCorps member
- Changes in income or household size that change your eligibility for help, in some cases
- Certain errors made by the Marketplace, an insurer, or an enrollment assister
The full list and the current rules are on HealthCare.gov. State-based marketplaces follow similar rules but may add their own.
Deadlines and start dates at a glance
| Event | Window to enroll | When coverage typically starts |
|---|---|---|
| Losing coverage | 60 days before to 60 days after the loss | First of the month after you pick a plan |
| Marriage | 60 days after | First of the following month |
| Birth, adoption, foster placement | 60 days after | Date of the event |
| Moving | 60 days after | First of the month after you pick a plan |
| Gaining citizenship or lawful presence | 60 days after | First of the month after you pick a plan |
| Release from incarceration | 60 days after | First of the month after you pick a plan |
Start dates can vary, so read your eligibility notice carefully. Coverage begins only after you pay your first premium.
Documents to have ready
The Marketplace can ask you to verify your event before coverage takes effect. Uploading documents early keeps things moving.
| Event | Examples of acceptable documents |
|---|---|
| Losing job-based coverage | Letter from employer or insurer with the coverage end date, COBRA notice, pay stub showing deductions ended |
| Losing Medicaid or CHIP | Notice of termination from the state agency |
| Marriage | Marriage certificate or license |
| Birth or adoption | Birth certificate, hospital record, adoption or foster placement paperwork |
| Moving | Lease, mortgage statement, utility bill, or mail showing old and new addresses, plus proof of prior coverage |
| Citizenship or lawful presence | Naturalization certificate, immigration documents |
If you are told to submit documents, do it within the stated deadline. Missing that step is one of the most common reasons a special enrollment falls through.
What does not qualify
Some situations feel like emergencies but do not create a Special Enrollment Period on the Marketplace:
- Choosing to drop your plan or letting it lapse for non-payment
- A new diagnosis or a change in your health
- Losing a short-term plan or a health care sharing arrangement, since those are not considered qualifying coverage
- Simply being unhappy with your current plan
In these cases, your next chance is open enrollment, unless another event happens first. Medicaid and CHIP accept applications any time of year if you qualify.
Special enrollment rules for employer plans
Job-based plans follow different rules under federal law. If you gain a dependent through marriage, birth, or adoption, or lose other coverage, you generally have 30 days to enroll in your employer's plan. If you lose Medicaid or CHIP, or become eligible for a state premium assistance program, you generally have 60 days. Ask your HR department for the exact deadline and forms.
Special enrollment rules for Medicare
Medicare has its own set of Special Enrollment Periods that work differently from the Marketplace. Common ones include:
- An eight-month window to enroll in Part B after employer coverage from active employment ends
- Windows to change Medicare Advantage or Part D plans when you move out of your plan's service area, move into or out of a nursing facility, or lose other creditable drug coverage
- A window to switch to a plan with a 5-star rating
If you are 65 or older and losing job-based coverage, do not apply for a Marketplace plan without checking your Medicare timing first. A licensed Medicare agent can help you sort out which windows apply.
How to make your special enrollment go smoothly
- Act early. If you know coverage is ending, start the application before the end date.
- Gather documents first. Have the proof of your event ready to upload.
- Estimate income for the whole year. Your premium tax credit is based on annual income, even if the event happens in July.
- Check networks and prescriptions. You are choosing a plan quickly, but the plan still needs to cover your doctors and medications.
- Pay the first premium immediately. Coverage is not active until the insurer receives payment.
- Ask for help if you are unsure. A licensed agent can confirm whether your event qualifies and handle the application with you. Our list of questions to ask a health insurance agent can help you vet one quickly.
Talk to a licensed agent for free
Health insurance agents and brokers are paid by the insurance carriers, so you pay nothing extra for their help, and your premium is the same whether you enroll with an agent or on your own. When you have only 60 days to act, an agent can confirm your qualifying event, help you gather the right documents, compare plans against your doctors and prescriptions, and make sure your coverage starts on time. You can find a licensed health insurance agent near you or browse health insurance agents by state at no cost.
Frequently asked questions
How long do I have to enroll after a qualifying life event?
For Marketplace plans, you generally have 60 days from the date of the event. If you know you are about to lose coverage, you can usually apply up to 60 days before the loss so your new plan starts without a gap. Employer plans typically give you 30 days.
Is losing coverage because I stopped paying my premium a qualifying event?
No. Voluntarily dropping a plan or losing it for non-payment does not create a Special Enrollment Period. Losing coverage because a job ended, an employer stopped offering it, or COBRA ran out does qualify.
Does moving qualify me for a special enrollment period?
Moving to a new ZIP code or county can qualify if it changes the plans available to you. In most cases you must have had qualifying coverage for at least one day in the 60 days before the move. Moving only for medical treatment or a vacation does not count.
What documents will the Marketplace ask for?
It depends on the event. Common examples are a letter from your employer or insurer showing the coverage end date, a marriage certificate, a birth certificate or hospital record, and proof of your new address such as a lease or utility bill. Upload them promptly to avoid delays.
When does coverage start after a special enrollment?
For most events, coverage starts on the first day of the month after you pick a plan. For birth, adoption, or foster placement, coverage can go back to the date of the event. Check your eligibility notice for the exact date.
Sources
- HealthCare.gov: Special Enrollment Period
- HealthCare.gov: Qualifying life event
- HealthCare.gov: Medicaid and CHIP
- Medicare.gov: Joining a health or drug plan
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