Special Enrollment Period
Open Enrollment ended on January 31st, 2017, meaning that the only way to buy health insurance for the year is to qualify for a Special Enrollment Period. These are 60-day windows following certain life events, when you and your family can buy health insurance. They usually involve a change in family status or loss of health coverage.
Here is a list of reasons that qualify you for a special enrollment period:
Loss of Qualifying Health Coverage
- Lost coverage through a job, or through another person's job. This also applies if you're now eligible for help paying for coverage because your employer stops offering coverage or the coverage isn't considered qualifying coverage.
- Medicaid or Children's Helath Insurance Program (CHIP) coverage (including pregnancy-related coverage and medically needy coverage).
- Individual or group health plan coverage that ends during the year.
- Coverage under your parent's health plan (if you're on it). If you turn 26 or the maximum dependent age allowed in your state and lose coverage, you can qualify for this Special Enrollment Period.
Note: This doesn't include loss of coverage because you didn't pay your premiums, or if your coverage was taken away because of fraud or intentional misrepresentation.
Changes in Household Size
- Got married
- Had a baby, adopted a child, or placed a child for foster care
- Got divorced or legally separated or had a death in the family and lost health coverage.
- Gained or became a dependent due to a child support or other court order.
Changes in Primary Place of Living
- Moving to a new home in a new ZIP code or county.
- Moving to the U.S. from a foreign country or United Sates 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 a Special Enrollment Period.
Change in Eligibility For Marketplace Coverage or Help Paying For Coverage
- Enrolled in Marketplace coverage and report a change that makes you:
- Newly eligible for help paying for coverage.
- Newly ineligible for help paying for coverage.
- Eligible for a different amount of help paying for out-of-pocket costs, such as copays.
- Become newly eligible for Marketplace coverage because you’ve become a citizen, national, or lawfully present individual.
- Become newly eligible for Marketplace coverage after being released from incarceration (detention, jail, or prison).
- Gain or maintain status as a member of a federally recognized tribe or Alaska Native Claim Settlement Act (ANCSA) Corporation shareholders (a status that lets you change plans once per month, and lets your dependents enroll in or change plans with you).
- Become newly eligible for help paying for Marketplace coverage because you moved to a different state and you were previously both of these:
- Ineligible for Medicaid coverage because you lived in a state that hasn’t expanded Medicaid.
- Ineligible for help paying for coverage because your household income was below 100% of the Federal Poverty Level (FPL).
Enrollment or plan error:
- Weren’t enrolled in a plan or were enrolled in the wrong plan because of:
- Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, navigator, certified application counselor, or agent or broker).
- A technical error or another Marketplace-related enrollment delay.
- The wrong plan data (like benefit or cost-sharing information) was displayed on HealthCare.gov at the time that you selected your health plan.
- Can prove your Marketplace plan has violated a material provision of its contract.
Other Qualifying life events:
- Applied for Medicaid or Children’s Health Insurance Program (CHIP) coverage during the Marketplace Open Enrollment Period, or after a qualifying event, and your state Medicaid or CHIP agency determined you (or anyone in your household) weren’t eligible.
- Are a victim of domestic abuse or spousal abandonment and want to enroll yourself and any dependents in a health plan separate from your abuser or abandoner.
- Submitted documents to clear your data matching issue after your coverage was ended.
- Are under 100% of the Federal Poverty Level (FPL), submitted documents to prove that you have an eligible immigration status, and didn’t enroll in coverage while you waited for your documents to be reviewed.
- Are an AmeriCorps service member starting or ending AmeriCorps service.
- Can show you had an exceptional circumstance that kept you from enrolling in coverage, like being incapacitated or a victim of a natural disaster.