What Is The Special Enrollment Period?

 

Special enrollment opportunities

Enroll in or change 2022 plans — only with a Special Enrollment Period

If you don’t qualify for a 2022 Special Enrollment Period, you can enroll in any 2023 health plan right now. Open Enrollment ends January 15, 2023.

If you qualify for a 2022 Special Enrollment Period

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Special Enrollment Period (SEP)

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time. Job-based plans must provide a Special Enrollment Period of at least 30 days.

Life changes that can qualify you for a Special Enrollment Period

Notice:Important: If you had a change more than 60 days ago but since January 1, 2020If you qualified for a Special Enrollment Period but missed your deadline to enroll in coverage because you were impacted by the COVID-19 emergency, you may be eligible for a Special Enrollment Period.If you or anyone in your household lost qualifying health coverage in the past 60 days (or more than 60 days ago but since January 1, 2020) OR expects to lose coverage in the next 60 days, you may qualify for this Special Enrollment Period through the application.If you had a life event other than a loss of coverage more than 60 days ago and missed your Special Enrollment Period, contact Us.

Changes in household

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

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.

Died. You’ll qualify for a Special Enrollment Period if someone on your Marketplace plan dies which causes you to lose your current health plan.

Changes in residence

You may qualify you for a Special Enrollment Period if you move to:

New home in a new ZIP code or county

The U.S. from a foreign country or United States territory

Or, move to or from:

Place you attend school (if you're a student)

Place you both live and work (if you're a seasonal worker)

Shelter or other transitional housing

Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.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.

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 more than 60 days ago but since January 1, 2020) OR expects to lose coverage in the next 60 days.Notice:If you lost coverage more than 60 days ago, but since January 1, 2020, and didn’t enroll sooner because you were impacted by the COVID-19 emergency declared by FEMA, you may still qualify for a Special Enrollment Period.

You may qualify for a Special Enrollment Period if you lost:

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 you lose health coverage through a parent or guardian because you're no longer a dependent.Notice:Voluntarily dropping coverage you have as a dependent doesn't qualify you for a Special Enrollment Period unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.

Individual health coverage

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.

Your household income decreased, and now you qualify for savings on a Marketplace plan.

Notice:You won’t qualify for a Special Enrollment Period if you lost coverage because you didn’t provide required documentation.

Medicaid or the Children’s Health Insurance Program (CHIP) coverage (or were denied Medicaid/CHIP

You may qualify for a Special Enrollment Period if you lose or were denied Medicaid or CHIP coverage because:

You're no longer eligible. Like if you had a change in household income that makes you ineligible for Medicaid.

Your child ages off CHIP.

You applied for Medicare/CHIP or Marketplace coverage during Open Enrollment or with a different Special Enrollment period and were told you might be eligible for Medicaid/CHIP. But, when your state agency told you that you weren’t eligible, Open Enrollment or your Special Enrollment Period had already ended.

Eligibility for Medicare

You may qualify for a Special Enrollment Period if you lose 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.

Medicare Parts B or D only.

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 lose health coverage because:

You turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent’s plan.

A family member loses health coverage or coverage for their dependents.

A divorce or legal separation.

The death of a family member.

You’re no longer a dependent.

You won’t qualify for a Special Enrollment Period if you chose to drop the coverage you have as a dependent, unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.

An employer offer to help with the cost of coverage

You may qualify for a Special Enrollment Period if you (or anyone in your household) were offered an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days OR expects to in the next 60 days.Note: Your employer may refer to an individual coverage HRA by a different name, like the acronym “ICHRA.”If you qualify to enroll in Marketplace coverage through this Special Enrollment Period, contact us.

More qualifying changes

Other situations that may qualify you for a Special Enrollment Period:

Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

Becoming a U.S. citizen

Leaving incarceration

Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member. Learn about Special Enrollment Periods for complex issues.

You may have to verify your information

When you apply, you must attest that the information you provide on the application is true, including the facts that qualify you for a Special Enrollment Period. You may be required to submit documents that confirm your eligibility to enroll based on the life event you experience.

What if I’m turned down for a Special Enrollment Period, but I think I qualify?

You can appeal the decision. Learn how to file an appeal.

What if something outside my control prevented me from getting coverage during the Open Enrollment Period?

In a few very limited situations, you may qualify for a Special Enrollment Period. Get details about these limited situations.