Special Enrollment Periods
The law permits enrollment in health insurance only during specific periods during the year. There is an open enrollment period each year in the fall. Also, some life events can trigger a special enrollment period.
How to get health insurance coverage outside of the open enrollment period
Once the Fall Open Enrollment Period ends, you can only sign up or change your health insurance if you qualify for a Special Enrollment Period.
What life events trigger a Special Enrollment Period?
You can enroll in a health insurance policy no later than the last day of the month. The coverage will begin on the first day of the following month.
If you had a baby, placed a child for foster care, or adopted a child, health insurance coverage can start the day of the change. It can be retroactive even if you sign up for insurance 60 days afterward.
If divorce or legal separation caused you to lose health insurance, you are eligible to enroll during a special enrollment period. However, without loss of coverage, divorce, or separation alone does not trigger a special enrollment period.
If you lost health insurance protection because someone on your Marketplace plan dies, you would qualify.
You may qualify for a special enrollment period if you move:
- To a new zip code or county
- To the US from a foreign country or US territory
- To or from the place where you attend school as a student
- To or from the place where you live and work as a seasonal employee
- To or from a shelter or transitional housing
Note: Moving or staying somewhere for vacation for the purpose of medical treatment does not qualify enrollment
In most situations, you need proof that you had qualifying health insurance for at least a day during the 60 days before moving.
Loss of Coverage
If you or someone in your household lost qualifying health insurance in the past 60 days, you might qualify for a special enrollment period. Also, you may be eligible if you expect to lose coverage in the next 60 days.
- Losing employer-sponsored coverage
- Phase-out of an individual health policy that you bought yourself
- Loss of Medicare, Medicaid, or CHIP eligibility
- Losing coverage provided by a family member
Employer Help with the Cost of Coverage
If you or a household member gained access to individual HRA (Health Reimbursement Arrangement) in the past 60 days or expect to in the next 60 days, you might qualify for a special enrollment period.
- Becoming a member of a federally recognized tribe
- Gaining status as a shareholder in an Alaska Native Claims Settlement Act Corporation
- Exiting prison or incarceration
- Starting or ending service with National and State AmeriCorps, VISTA or NCCC
If you do not qualify for any of the above circumstances, you can enroll during the annual enrollment period from November 1 to December 15.
If you think you qualify for a special enrollment period but were turned down, you can appeal the decision.
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