What is a special enrollment period and do I qualify?
Life events that let you enroll outside open enrollment, the 60 day deadline, and the proof you will need.
Outside open enrollment, you need a qualifying life event to buy a Marketplace plan. That opens a special enrollment period, usually 60 days long.
Events that qualify
Loss of coverage:
- Losing job based coverage, yours or a family member's
- Losing Medicaid or CHIP eligibility
- Aging off a parent's plan at 26
- A student or individual plan ending
- Losing coverage through divorce or the death of a spouse
Household changes:
- Marriage
- Having a baby, adopting, or placing a child in foster care
- Divorce or legal separation, if it causes loss of coverage
- A death in the household
Moves:
- Moving to a new ZIP or county with different plan options
- Moving to or from a place you attended school
- Moving to or from seasonal work housing
- Moving to the United States from a foreign country
Other:
- A change in income that affects your eligibility for savings
- Becoming a citizen or gaining lawfully present status
- Leaving incarceration
- A Marketplace or plan error that affected your enrollment
What does not qualify
- Voluntarily dropping your coverage
- Losing coverage for not paying your premiums
- Getting sick or receiving a diagnosis
- Simply changing your mind about a plan you chose
This is why going without coverage is a real risk rather than a theoretical one. A diagnosis does not open a door. If you are uninsured and outside open enrollment without a qualifying event, you may be waiting until November.
The deadline
Sixty days from the event, in most cases. For a loss of coverage you can also apply up to 60 days before it happens, which is the better move when you have notice, because it avoids a gap.
Moving requires that you had coverage for at least one of the 60 days before the move, with limited exceptions.
Proof
The Marketplace will usually ask for documentation. Have it ready.
- Loss of coverage: a termination letter from the employer or carrier showing the end date
- Marriage: a marriage certificate
- Birth or adoption: a birth certificate or placement papers
- Move: a lease, mortgage statement, or utility bill at the new address, plus proof of prior coverage
Upload it promptly. Missing the document deadline can cancel the enrollment you just completed. See the document checklist.
When coverage starts
Usually the first of the month after you enroll. For birth or adoption, coverage can be backdated to the date of the event.
If you are between coverage right now, apply today rather than at the end of the window, since the start date depends on when you enroll rather than when the event happened.
See coverage after losing a job.
Common follow-up questions
How long is a special enrollment period?
Usually 60 days from the qualifying event. For a planned loss of coverage you can apply up to 60 days beforehand.
Does getting sick qualify?
No. A diagnosis is not a qualifying event, which is the main argument for not going without coverage.
Do I have to prove the event?
Usually yes. Have documentation ready and upload it quickly, because missing the deadline can cancel your enrollment.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
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