Jeffrey Wade
Open enrollment for health insurance in the US occurs annually, from November 1 to January 15. However, you can still purchase health insurance after open enrollment under certain circumstances. These circumstances include qualifying life events, such as getting married, having a baby, or losing your health coverage. Additionally, individuals who are American Indians or Alaskan Natives can enroll in health insurance year-round, and those who qualify for Medicaid or CHIP can also enroll at any time. Short-term health insurance is another option for those who need coverage outside of the open enrollment period, although it does not meet the Affordable Care Act's requirements for minimum essential coverage.
| Characteristics | Values |
|---|---|
| Can you get medical insurance after open enrollment? | Yes, but only if you have a qualifying life event. |
| What is a qualifying life event? | Events such as getting married, having a baby, getting divorced, losing your job, losing health coverage, or a change in income. |
| What if I don't have a qualifying life event? | You may still have options, such as short-term health insurance, or combining a health care sharing ministry plan with a direct primary care membership. |
| Are there any exceptions to the qualifying life event requirement? | Yes, American Indians and Alaskan Natives can enroll in health plans year-round. Additionally, those eligible for Medicaid/CHIP can also enroll at any time. |
| How long is the Special Enrollment Period after a qualifying life event? | Typically 60 days from the date of the qualifying event. |
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What You'll Learn
Qualifying for a Special Enrollment Period
Open Enrollment happens every year, from November 1 to January 15. During this period, anyone can apply for health insurance. However, if you miss this period, you may still be able to qualify for a Special Enrollment Period, which is a period of time outside of Open Enrollment when you can enroll in or change your Marketplace plan.
To qualify for a Special Enrollment Period, you must have experienced certain "life events" within the past 60 days or expect to experience them in the next 60 days. These include:
- Losing health coverage or expecting to lose it, such as through your employer or a family member's employer.
- Gaining a new dependent, such as through birth, adoption, or placement of a child in foster care.
- Changes in your household income that affect your eligibility for savings on a Marketplace plan.
- Permanent moves to a new state or within your state that make new health plans available to you.
- Becoming a citizen, national, or legal resident of the United States.
It's important to note that not all life events qualify for a Special Enrollment Period. For example, divorce or legal separation does not qualify unless it results in a loss of health coverage. Additionally, moving solely for medical treatment or vacation does not qualify.
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Short-term health insurance options
Short-term health insurance, also known as temporary health insurance, can be a good option if you are stuck in a coverage gap or need to purchase a policy outside of open enrollment. This type of insurance is available in most states, but it is important to note that 14 states and the District of Columbia do not offer short-term plans.
Short-term health insurance plans are typically underwritten by private companies and are not subject to the same regulations as ACA-compliant plans. As a result, they may not cover all the essential health benefits outlined in the Affordable Care Act (ACA) and may have limitations on pre-existing conditions. Short-term plans are also not considered minimum essential coverage, so losing one is not typically a qualifying life event for a Special Enrollment Period.
Short-term health insurance plans can provide fast and flexible coverage, often taking effect the day after your application is received. The duration of these plans can vary, with some offering coverage for up to four months, including renewals. Before September 1, 2024, short-term plans could have a total duration of up to three years, depending on the state and specific policy.
When considering a short-term health insurance plan, it is important to carefully review the policy to understand any exclusions or limitations on coverage. These plans may not cover outpatient prescriptions, and enrollees should be aware of potential balance billing, which could result in higher out-of-pocket costs.
Short-term health insurance can be a temporary solution until you can choose a longer-term option or qualify for a Special Enrollment Period due to a qualifying life event, such as having a baby, getting married, moving, or losing health coverage.
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Losing health coverage
If you lose Medicaid or Children's Health Insurance Program (CHIP) coverage, you may qualify for a Special Enrollment Period. You may qualify if you are no longer eligible due to a change in household income or if your child ages out of CHIP. Losing Medicaid or CHIP coverage due to failure to provide required documents does not qualify you for a Special Enrollment Period.
American Indians and Alaskan Natives can enroll in exchange plans year-round. There is also a year-round enrollment option for subsidy-eligible applicants whose household income does not exceed 150% of the federal poverty level. Additionally, some states have programs that allow eligible applicants to enroll anytime, such as the Covered Connecticut program.
Short-term health insurance is another option available in most states. These plans can provide some coverage if your alternative is to remain uninsured. However, they are not intended for full-year coverage.
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American Indians and Alaskan Natives can enroll year-round
While open enrollment for 2025 health plans has ended in most states, American Indians and Alaskan Natives can enroll in exchange plans year-round. This is also the case for subsidy-eligible applicants whose household income does not exceed 150% of the federal poverty level.
To qualify for year-round enrollment, you need to provide documentation to the Marketplace. This can include a document issued by a federally recognized Tribe indicating Tribal membership, or a document from an Alaska Native village or Tribe acknowledging descent, affiliation, or shareholder status. A certificate of degree of Indian blood issued by the Bureau of Indian Affairs can also be provided.
It is important to note that tribal enrollment is determined and set by individual Tribes, not the Bureau of Indian Affairs, and so uniform membership requirements across all Tribes do not exist.
Additionally, members of federally recognized Tribes and Alaska Native Claims Settlement Act (ANCSA) shareholders can enroll in a Marketplace plan at any time. This includes health coverage through Marketplace plans, Medicaid, and the Children's Health Insurance Program (CHIP).
Outside of the yearly Open Enrollment Period, you can still qualify for a Special Enrollment Period if you have experienced certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child.
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Life events that qualify for a Special Enrollment Period
Losing health coverage
If you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days, you may qualify for a Special Enrollment Period. This includes losing health coverage through an employer or the employer of a family member, including a parent or guardian. Losing Medicaid or CHIP coverage due to a change in household income or ineligibility also qualifies you for a Special Enrollment Period.
Getting married
If you recently got married, you may qualify for a Special Enrollment Period. Pick a plan by the last day of the month, and your coverage can start the first day of the next month.
Having a baby or adopting a child
If you recently had a baby, adopted a child, or placed a child for foster care, you may qualify for a Special Enrollment Period. Your coverage can start the day of the event, even if you enroll in the plan up to 60 days afterward.
Moving
Moving to a different state or a move within your state that makes new health plans available to you may qualify you for a Special Enrollment Period.
Natural disaster or public health emergency
Being affected by an unexpected and uncontrollable event, such as a natural disaster or a public health emergency, may qualify you for a Special Enrollment Period.
Other qualifying life events
Other life events that may qualify for a Special Enrollment Period include turning 26 and aging out of a parent's health plan, turning 65 and becoming eligible for Medicare, or gaining U.S. citizenship.
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Frequently asked questions
Yes, you can purchase medical insurance outside of the Open Enrollment Period, but only under certain circumstances. You may qualify for a Special Enrollment Period if you experience a qualifying life event, such as getting married, having a baby, or losing your job. During this period, you can enroll in or change your Marketplace plan.
Qualifying life events for a Special Enrollment Period include, but are not limited to, the following:
- Getting married or divorced
- Having a baby, adopting a child, or placing a child for foster care
- Losing your job or experiencing a change in income
- Losing your health coverage or eligibility for Medicare, Medicaid, or CHIP
- Moving to a new state or location
The Special Enrollment Period typically lasts for 60 days from the date of the qualifying life event. During this time, you can shop for health insurance on a private or public exchange and may have the same plan options as during the Open Enrollment Period.
