Special enrollment periods: what qualifies, how long you have

A special enrollment period lets you sign up for a Marketplace plan, or change plans, outside Open Enrollment after a qualifying life event, and in most cases you have 60 days from the event to pick a plan. The events that qualify fall into four groups: losing health coverage, changes in your household, moving, and a short list of other changes. Start dates depend on the event.

Which life events qualify?

Losing health coverage

Losing job-based coverage counts, including a parent’s plan when you turn 26. So does losing individual coverage because a plan ends or leaves your area, losing Medicaid or CHIP, losing premium-free Medicare Part A, and reaching the end of COBRA. Dropping coverage on purpose doesn’t count. Neither does losing it for unpaid premiums. For a loss of coverage, the window also opens 60 days before the loss, so you can line up a new plan in advance, and losing job-based coverage comes with its own timing and COBRA questions.

Changes in your household

Getting married, having a baby, adopting a child or having a child placed with you all qualify. Divorce alone doesn’t. A divorce, legal separation or death in the household qualifies when it ends your coverage. Marriage has an extra condition in most cases: at least one of you needs to have had qualifying coverage for at least a day in the 60 days before the wedding.

Moving

A move can qualify if it takes you to a new ZIP code or county, to the U.S. from abroad or a U.S. territory, to or from a school as a student, or to or from a seasonal work location. In most cases you also need to have had qualifying health coverage for at least one day in the 60 days before the move. Keep your lease or a utility bill. Moving only for medical treatment, or staying somewhere on vacation, doesn’t count.

Income and other changes

If you’re already enrolled, an income change that affects your eligibility for the tax credit or for extra savings can let you change plans. Other qualifying events include becoming a U.S. citizen, gaining membership in a federally recognized tribe, leaving incarceration, starting or ending AmeriCorps service, and being offered an individual coverage HRA by an employer for the first time. A natural disaster or another situation outside your control that kept you from enrolling can qualify too. Report income changes either way.

How long do you have?

The standard window is 60 days. For a loss of coverage, you can also start up to 60 days before the loss. The clock runs from the event itself, not from when you get around to it, so a baby born in March and reported in June is outside the window.

Say you get married on June 14. Your window then runs about 60 days, to mid-August, and the day you pick a plan inside it decides when coverage starts. Pick one by June 30, and coverage can start July 1. Pick one on July 20, and it starts August 1.

What proof should you keep?

On the federal Marketplace, you may be asked to prove the event. After you pick a plan, you have 30 days to send documents, and you can’t use the coverage until your eligibility is confirmed and your first premium is paid. Documents that commonly work:

• For a lost plan, a letter from the employer or insurer showing the date coverage ended
• For a marriage, the marriage certificate
• For a birth, the birth certificate, and for an adoption, the adoption or placement papers
• For a move, a lease, mortgage statement or utility bill at the new address, plus proof of coverage in the 60 days before the move

Keep copies until you’ve filed next year’s taxes.

Is special enrollment retroactive?

Only in a few cases. For most events, coverage starts the first day of the month after you pick a plan. The main exception is a birth, an adoption or a child placed with you, where coverage can start on the day of the event even if you enroll up to 60 days later. Marriage runs on the calendar month: pick a plan by the last day of the month and coverage can start the first of the next. For a loss of coverage, picking a plan before the loss lets the new one start the first of the month after the old one ends.

What if you missed Open Enrollment?

Start by checking the last 60 days for any of the events above. Those still count. Medicaid and CHIP take applications all year, and coverage can start right away if you qualify. If your employer offers a plan, it has its own special enrollment rules, often with a 30-day deadline, and our enrollment guides walk through the forms. Otherwise, the next Open Enrollment usually runs November 1 through January 15 on the federal Marketplace, and some states run their own dates. To have coverage start January 1, enroll by December 15.

If you’re inside a window now, look at plans and your tax credit before it closes, and ask us to check your doctors and prescriptions against them.

Quick answers

Does moving across town count?

Only if your ZIP code or county changes, and usually only if you had qualifying coverage at some point in the 60 days before the move.

Does a pay cut open a special enrollment period?

Not by itself, in most cases, if you’re uninsured. If you’re already enrolled, an income change that changes your eligibility for savings can let you switch plans, so report it either way.

Do I have to prove the event?

Often, yes. The Marketplace can ask for documents, like a letter showing when coverage ended, a marriage certificate or proof of your new address, and you get 30 days after picking a plan to send them.