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How does the “marriage” special enrollment period work?

When you get married, you can qualify for a special enrollment period (SEP).  You and your spouse can sign up for coverage in the marketplace.

The special enrollment period lasts for 60 days from the date of marriage.  If you enroll in coverage through the marriage SEP, coverage will start on the first day of the following month.

If you live in a healthcare.gov state, restrictions apply.  To be eligible for the marriage SEP, at least one of you must have been enrolled in minimum essential coverage (such as a job-based plan, Marketplace plan, or Medicaid) for at least 1 day during the 60 days preceding the date of marriage.

There are exceptions to this limit on marriage SEP eligibility:

  • If at least one spouse was living in a foreign country or U.S. territory during the 60-days prior to enrollment, the prior coverage requirement does not apply
  • If at least one spouse is a member of a federally recognized Native American tribe or an Alaskan Native, the prior coverage requirement does not apply

In addition, for people currently enrolled in the marketplace through healthcare.gov, the marriage SEP can only be used either to add the new spouse to the current marketplace plan or to enroll the new spouse in a separate marketplace plan.  The currently-enrolled spouse cannot use the marriage SEP to change plans.

This restriction on plan selection does not apply for Native Americans or Alaska Natives, or for victims of domestic abuse or spousal violence.

These restrictions on eligibility for the marriage SEP and on plan selection do not apply in the SHOP marketplace or for people using an SEP to join an employer-sponsored group health plan.

State-run Marketplaces have flexibility to expand special enrollment opportunities for consumers. Check with your State Marketplace for more information.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.