Scroll To Top

Healthcare Special Enrollment

What is HealthCare Special Enrollment Period(s)?

A time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days.

Life events that may qualify you for a Special Enrollment Period

Loss of health insurance

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. Coverage losses that may qualify you for a Special Enrollment Period:

  • Losing job-based coverage

You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:

    • Your employer stops offering coverage.
    • You leave a job where you had health coverage (even if you left your job by choice or were fired).
    • You have a reduction in work hours that causes you to lose your job-based plan.
    • Your job-based plan doesn’t offer qualifying health coverage and as a result you become newly eligible for a premium tax credit. Most job-based plans count as qualifying health coverage. To find out if your employer’s coverage meets the standards, ask your employer to complete the Employer Coverage Tool (PDF).
    • Your job-based health plan is ending for the year and you choose not to renew it. Note: If the plan is affordable and meets minimum value standards, you can buy Marketplace insurance but won’t qualify for a premium tax credit or other savings.
    • Your former employer stops contributing to your retirement coverage, requiring you to pay full cost.

    Note: You DON’T qualify for a Special Enrollment Period if:

    • You voluntarily drop your job-based coverage during your coverage year while still working for your employer.
    • You lose your job-based coverage because you didn’t pay your premium.
  • Losing COBRA coverage

    Some special rules apply if you’re losing COBRA continuation coverage.

    You DO qualify for a Special Enrollment Period if:

    • Your COBRA coverage runs out.
    • Your former employer stops contributing to your COBRA coverage, requiring you to pay the full cost.

    You DON’T qualify for a Special Enrollment Period if:

    • You decide to end COBRA early (and are paying the full cost yourself).
    • You lose your COBRA coverage because you didn’t pay your premiums.

    Note: You don’t need a Special Enrollment Period if you voluntarily end COBRA early during a Marketplace Open Enrollment Period. You can drop your COBRA plan and enroll in a Marketplace plan at that time.

  • Losing individual health coverage for a plan or policy you bought yourself

    You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:

    • Your individual plan or your Marketplace plan is discontinued (no longer exists).
    • You lose eligibility for a student health plan.
    • You lose eligibility for a plan because you no longer live in the plan’s service area.
    • Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.

    Important: Losing individual coverage doesn’t qualify for a Special Enrollment Period if you voluntarily drop coverage, if you lose coverage because you didn’t pay your premiums, or if you lose Marketplace coverage because you didn’t provide required documentation when the Marketplace asked for more information.

  • Losing eligibility for Medicaid or CHIP

    You may qualify for a Special Enrollment Period if you lose Medicaid or the Children’s Health Insurance Program (CHIP) because:

    • You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.
    • Your child ages off CHIP.
  • Losing eligibility for Medicaid or CHIP

    You may qualify for a Special Enrollment Period if you become no longer eligible for premium-free Medicare Part A.

    You don’t qualify for a Special Enrollment Period if:

    • You lose Medicare Part A because you didn’t pay your Medicare premium.
    • You lose Medicare Parts B, C, or D only.
  • Losing coverage through a family member

    You may qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen 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 job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for dependents.
    • You lose health coverage through a spouse due to a divorce or legal separation.
    • You lose health coverage due to the death of a family member.
    • You lose health coverage through a parent or guardian because you’re no longer a dependent.
    Important: Losing coverage you have as a dependent doesn’t qualify for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member lose coverage because you don’t pay your premium.

Changes in household size

You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:

  • Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
  • Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Death. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

Changes in residence

Household moves that qualify you for a Special Enrollment Period:

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or United States territory
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for an SEP.

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

More qualifying changes

Other life circumstances that may qualify you for a Special Enrollment Period:

  • Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving incarceration
  • AmeriCorps VISTA members starting or ending their service

For more FAQ's, contact an AIA agent or go online to healthcare.gov (Special Enrollment)