You can usually enroll in ACA Marketplace health insurance during the annual Open Enrollment Period. But if you experience certain life changes, you may qualify to enroll at another time through a Special Enrollment Period (SEP).
Common qualifying events include losing health coverage, getting married, having a baby, moving, or losing Medicaid or CHIP coverage.
The amount of time you have to enroll depends on the qualifying event. For many Special Enrollment Periods, the window is generally 60 days before or after the event, although different deadlines apply in some situations.
Here’s how Marketplace Special Enrollment works and how to determine whether you may qualify.
What Is a Marketplace Special Enrollment Period?
A Special Enrollment Period is a period outside annual Open Enrollment when you can enroll in or change ACA Marketplace health insurance because of a qualifying life event or other qualifying circumstance.
Without a Special Enrollment Period, you generally have to wait for the annual Open Enrollment Period to enroll in individual Marketplace coverage.
The important question isn’t simply whether Open Enrollment has ended. It’s whether something has happened that gives you a new opportunity to enroll.
At BenZen, we provide Marketplace enrollment assistance in Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.
For states that use the federal Marketplace, we use HealthSherpa to help eligible consumers browse available Marketplace plans, compare estimated costs, and enroll online with broker assistance at no additional cost.
Questions? Call (833) 700-3530 to connect with a licensed expert Monday–Friday, 9 a.m.–7 p.m. Eastern.
What Qualifies for Marketplace Special Enrollment?
Several life events and changes in circumstances can qualify you for a Special Enrollment Period.
Losing Health Insurance
Losing qualifying health coverage is one of the most common reasons for Special Enrollment.
Examples can include:
- Losing job-based health insurance
- Losing coverage through a spouse or parent
- Losing eligibility for an employer health plan because your work hours were reduced
- Reaching the end of COBRA continuation coverage
- Losing an individual health plan that qualifies as minimum essential coverage
Voluntarily dropping coverage generally doesn’t qualify. Losing coverage because you stopped paying your premiums also generally doesn’t create a Special Enrollment Period.
If you’re losing employer-sponsored insurance, see our guide to health insurance after losing a job for more information about your enrollment window and coverage options.
Losing Medicaid or CHIP
Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) can also give you an opportunity to enroll in Marketplace coverage.
This can happen because of changes in income, household circumstances, or state eligibility requirements.
The enrollment window following a loss of Medicaid or CHIP can differ from the standard window for other qualifying events, so check your eligibility and deadline rather than assuming you have only 60 days.
If your income has changed, you may also qualify for financial assistance toward a Marketplace plan.
Changes in Your Household
Certain household changes can qualify, including:
- Getting married
- Having a baby
- Adopting a child or having a child placed with you for adoption
- Placement of a child in foster care
- Divorce or legal separation when it causes you to lose qualifying health coverage
- Death of someone on your Marketplace plan when it causes you to lose eligibility for your current coverage
The rules and effective dates can differ depending on the event.
Moving
Certain permanent moves can qualify you for a Special Enrollment Period, including moving:
- To a new ZIP code or county
- To another state
- To the United States from another country or U.S. territory
- To or from certain transitional housing situations
Simply changing addresses doesn’t automatically qualify. Depending on the type of move, you may also need to show that you had qualifying health coverage before moving.
Other Qualifying Circumstances
Other situations may create a Special Enrollment opportunity, including certain changes involving:
- Citizenship or lawful presence
- Release from incarceration
- Marketplace enrollment errors or misinformation
- Exceptional circumstances that prevented enrollment
Because Special Enrollment rules depend on the specific situation, confirm your eligibility with HealthCare.gov, your state Marketplace, or a certified Marketplace professional.
How Long Does a Marketplace Special Enrollment Period Last?
For many qualifying life events, you generally have a 60-day enrollment window.
But when that window begins—and whether you can enroll before the event occurs—depends on the qualifying event.
For example, someone who knows they’re about to lose qualifying job-based health insurance can generally enroll during the 60 days before the coverage ends or the 60 days afterward.
Other events have different enrollment windows.
Don’t assume every Special Enrollment Period lasts exactly 60 days. Once you know which qualifying event applies to you, confirm the specific enrollment deadline.
Losing Job-Based Coverage?
If you’re losing employer health insurance, the date your coverage ends is particularly important. It may not be the same as your last day of employment.
Confirm the termination date with your employer or benefits administrator and begin comparing replacement coverage before that date when possible.
When Does Special Enrollment Coverage Start?
The effective date of your new Marketplace plan depends on your qualifying event and when you enroll.
In many situations, coverage begins on the first day of the following month after you select a plan. Certain qualifying events, such as the birth or adoption of a child, can have different effective-date rules.
If you’re replacing existing health insurance, compare:
When your current coverage ends and when your new coverage begins.
That can help you avoid an unintended gap between plans.
Can I Get Marketplace Savings During Special Enrollment?
Yes. Enrolling through a Special Enrollment Period doesn’t prevent you from qualifying for Marketplace financial assistance.
Depending on your eligibility and expected household income, you may qualify for:
Premium tax credits that reduce your monthly Marketplace premium.
Cost-Sharing Reductions that can lower deductibles, copays, coinsurance, and out-of-pocket limits if you’re eligible and enroll in a qualifying Silver plan.
Life events such as job loss or losing Medicaid can also change your household income, so don’t assume your previous eligibility for financial assistance is still the same.
How Do I Enroll Through a Special Enrollment Period?
If you think you qualify:
- Identify your qualifying event. Determine what changed and the date it occurred or will occur.
- Confirm your enrollment deadline. The available window depends on the qualifying event.
- Gather documentation. You may be asked for proof of your loss of coverage, move, marriage, or other qualifying circumstance.
- Update your household and income information. This can affect your eligibility for Marketplace financial assistance.
- Compare available plans. Look beyond premiums at deductibles, prescriptions, provider networks, copays, and expected healthcare costs.
- Enroll before your Special Enrollment Period expires.
Need Help With Marketplace Special Enrollment?
You can use HealthCare.gov or your state’s Marketplace to determine whether you qualify for a Special Enrollment Period and review available coverage.
At BenZen, we provide Marketplace enrollment assistance in Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.
For states that use the federal Marketplace, we use HealthSherpa to help eligible consumers browse available Marketplace plans, compare estimated costs, and enroll online with broker assistance at no additional cost.
Questions? Call (833) 700-3530 to connect with a licensed expert Monday–Friday, 9 a.m.–7 p.m. Eastern.
The Bottom Line
You don’t necessarily have to wait for Open Enrollment to get Marketplace health insurance.
If you’ve lost health coverage, moved, gotten married, had a baby, lost Medicaid or CHIP, or experienced another qualifying circumstance, you may qualify for a Special Enrollment Period.
For many qualifying events, the enrollment window is around 60 days—but the exact deadline and coverage effective date depend on what happened.
Start by identifying your qualifying event and its date. Then confirm your enrollment window and compare your coverage options before the deadline.
Related Articles
- Special Enrollment Periods: When you can enroll in Marketplace coverage outside Open Enrollment
- Best Health Insurance for Diabetes: How to compare Marketplace plans when you’re managing Type 2 diabetes
- Medicaid to Marketplace: What to do when Medicaid ends and how to compare Marketplace plans
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