In general, you can have a special enrollment opportunity to sign up for private, non-group coverage during the year, other than during Open Enrollment period, if you have a qualifying life event. Only one person in a household applying for coverage or financial assistance through the Exchange must qualify for a SEP in order for the entire household to qualify for the SEP. Events that trigger a special enrollment period (SEP) can include:
-Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity
-Gaining a dependent (for example, if you give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity in most states
-Loss of coverage due to loss of dependent status (for example, because of divorce, legal separation, death, or “aging off” a parents’ plan)
-A permanent move to another state or within a state if you move outside of your health plan service area (limitations apply)
-Exhaustion of COBRA coverage
-Cessation of employer contributions to COBRA premiums
-Losing eligibility for Medicaid or the Children’s Health Insurance Program. Please visit the Unwinding FAQs page for more information. Please click here for more information on Medicaid Unwinding.
-Income increases or decreases enough to change your eligibility for Marketplace subsidies
-Change in immigration status
-Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.
Note that some triggering events will only qualify you for a SEP in the health insurance Marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, the Marketplace must provide you with a special enrollment opportunity.
States have flexibility to expand special enrollment opportunities for consumers. Check with your State Marketplace for more information.