Special Enrollment Periods: Your Health Coverage Lifeline for Life's Big Moments
Outside of Open Enrollment, you can enroll in or change Marketplace plans if you qualify for Special Enrollment Period based on certain life changes or your estimated household income.
If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.
You may qualify for a Special Enrollment Period if:
You have a qualifying life event, like having a baby, getting married, moving, or health coverage (like coverage through your job, Medicaid, CHIP)
You gained newly eligible immigration status.
Your estimated household income is within a certain range.
Leaving incarceration
Being affected by an unexpected and uncontrollable event or natural disaster (like an earthquake, massive flooding, or a hurricane)
Found not eligible for Medicaid or CHIP coverage
Survivor of domestic abuse/violence or spousal abandonment
When you apply for Marketplace coverage and qualify for a Special Enrollment Period due to a life event, you may be asked to send documents to confirm that you qualify. You must send these documents before you can start using your coverage. You’ll find out if you have to provide documents after you submit your application. Details and instructions will be on your Marketplace Eligibility Notice. Your coverage start date is based on when you pick a plan. But you can’t use your coverage until we confirm your eligibility and you make your first premium payment. If your eligibility notice doesn't say you need to submit documents, you don’t have to. Simply pick a plan and enroll.
If you lost or will lose health coverage you must send documents showing the lost coverage and the date it ends.
If you already lost coverage, you must: Pick a plan within 60 days after the date coverage ended. (If you lost Medicaid or Children's Health Insurance Program (CHIP) coverage, you must pick a plan within 90 days after the date coverage ended.) Submit documents within 30 days of picking a plan.
Your coverage will start the first day of the month after you pick a plan.
If you will lose coverage in the future, you must: Pick a plan within 60 days before the date your coverage will end. Submit documents within 30 days of picking a plan.
Your coverage will start the first day of the month after your coverage ends and you pick a plan.
After you submit your documents…
You should get a letter in your HealthCare.gov account within a couple of weeks telling you if we confirmed your Special Enrollment Period. If your Special Enrollment Period is confirmed the ACA Marketplace will tell the insurance carrier the plan you picked. You’ll need to pay your first premium directly to the insurance company — not to the Health Insurance Marketplace. Your coverage won’t start until you pay your first premium.
If confirmation delays kept you from using your plan after the coverage start date, you may have to pay premiums for one or more previous months. When you do, medical expenses you had after the start date may be covered. This is called "retroactive" coverage.
If your Special Enrollment Period can’t be confirmed you’ll get a letter in your Marketplace account explaining why and can upload different documents to confirm.
