Jeffrey Wade
There are a few ways to get medical insurance outside of the yearly Open Enrollment Period. One way is to qualify for a Special Enrollment Period, which is a period of time (usually 60 days) during which you can buy a health plan, even if it's outside the normal Open Enrollment Period. To qualify for a Special Enrollment Period, you typically need to have experienced a significant life change, such as losing your job, getting married, having a baby, or moving to a new state. Additionally, losing your health coverage or having a change in income that affects your eligibility for tax credits or cost-sharing reductions can also make you eligible for a Special Enrollment Period. It's important to note that short-term health plans are also an option outside of the Open Enrollment Period, but they don't meet the Affordable Care Act's requirements for minimum essential coverage.
| Characteristics | Values |
|---|---|
| Special Enrollment Period | A period of time outside of Open Enrollment when you can enroll in or change Marketplace plans due to a life event or based on your income. |
| Qualifying life events | Getting married, having a baby, adopting a child, moving, losing health coverage, losing Medicaid or CHIP eligibility, expiring COBRA coverage, losing a job, getting divorced, or a death in the family. |
| Qualifying health coverage | Any health insurance that meets the law's minimum requirements for comprehensive health coverage, like Marketplace plans, Medicare, Medicaid, and CHIP. |
| Short-term health plans | Do not meet the Affordable Care Act's requirements for minimum essential coverage but can be purchased outside of Open Enrollment. |
| State-specific options | Basic Health Programs in New York, Minnesota, and Oregon; The ConnectorCare program in Massachusetts; The Covered Connecticut program; GetCoveredNJ; Health First Colorado; Child Health Plan Plus (CHP+). |
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What You'll Learn
Special Enrollment Periods
You may qualify for a SEP 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. This includes losing health coverage through your employer or the employer of a family member, or losing Medicaid or CHIP coverage. If you choose to drop the coverage you have as a dependent, you must also have had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan to qualify for a SEP.
Additionally, you may qualify for a SEP if you have experienced certain complex health care issues, such as facing a serious medical condition, natural disaster, or other emergencies that prevented you from enrolling on time. For example, an unexpected hospitalization or temporary cognitive disability. To qualify for a SEP due to a natural disaster, you must live in a county that is eligible to apply for "individual assistance" or "public assistance" by the Federal Emergency Management Agency (FEMA). You have 60 days from the end of the FEMA-designated incident period to complete your enrollment in Marketplace coverage.
In some states, there are other types of coverage that can be obtained outside of Open Enrollment. For instance, in New York, Minnesota, and Oregon, there are Basic Health Programs, while in Massachusetts, there is the ConnectorCare program for people who are newly eligible or who haven't enrolled before. In Connecticut, eligible applicants can enroll anytime through the Covered Connecticut program.
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Qualifying life events
A qualifying life event is a life-changing situation that can impact your health insurance. Experiencing a significant life change may allow you to change your health plan outside of the annual enrollment period.
- Loss of 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 family member, or losing Medicaid or Children's Health Insurance Program (CHIP) coverage.
- Change in residence: Moving to a different zip code, county, or state that changes your health plan area may qualify you for a Special Enrollment Period. Moving only for medical treatment or vacation does not qualify.
- Changes in household composition: Getting married, having a baby, adopting a child, or placing a child for foster care can qualify you for a Special Enrollment Period.
- Changes in income: A decrease in household income that makes you eligible for savings on a Marketplace plan may qualify you for a Special Enrollment Period.
- Other: Qualifying life events can also include earning U.S. citizenship, turning 65, or experiencing a natural disaster, pandemic, or public health emergency.
It is important to note that not all life changes will qualify you for a Special Enrollment Period. For example, choosing to drop your current coverage or getting divorced or legally separated without losing coverage do not qualify. Additionally, short-term health insurance plans and health care sharing ministry plans are available year-round but do not provide comprehensive coverage or cover pre-existing conditions.
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State-specific options
Colorado
In Colorado, the Open Enrollment Period is from November 1 to January 15. Outside of this period, you can still buy health insurance or make changes to your current plan if you experience certain qualifying life events, such as losing your job's health insurance, changes in your income, moving, getting married, or having a baby. These qualifying life events make you eligible for a 60-day Special Enrollment Period. Additionally, you can connect to free or low-cost health insurance through Health First Colorado (Colorado's Medicaid program) or the Child Health Plan Plus (CHP+) program.
California
In California, you can apply for a health plan outside the Open Enrollment Period if you have experienced a qualifying life event within the last 60 days. Qualifying life events include losing your Medi-Cal coverage, losing your employer-sponsored coverage, or no longer being eligible for student health coverage. Additionally, if you move to California from out of state or within California and gain access to a new Covered California health insurance plan, you can use the special enrollment period to enroll in coverage.
New Jersey
New Jersey offers the GetCoveredNJ program, which allows uninsured or underinsured residents to indicate their interest in coverage when completing their state income tax returns. Through this program, consumers can receive an invitation to apply and enroll outside of the Open Enrollment Period. If you qualify for a Special Enrollment Period (SEP), you typically have up to 60 days to enroll or change your plan. New Jersey also has NJ FamilyCare, a publicly funded health insurance program that offers free or low-cost health coverage year-round.
Other State-specific Options
In addition to the above, some general state-specific options include:
- Short-term health insurance: Available in most states, short-term health insurance can provide temporary coverage if you need to purchase a policy outside of the open enrollment period. However, these plans are not as comprehensive as ACA-regulated policies and may not cover all essential health benefits.
- State-run exchanges: Some states have their own state-run exchanges that may have different rules and requirements for special enrollment periods.
- Medicaid and CHIP: If you qualify for Medicaid or your children are eligible for the Children's Health Insurance Program (CHIP), you can generally apply for coverage at any time, as these programs have year-round enrollment.
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Short-term health plans
A federal rule issued in 2024 limits short-term limited duration insurance (STLDI) plans to a duration of three months, with a total duration, including renewals, of no more than four months. This rule also allows consumers to buy another STLDI policy from a different insurer after their policy ends, provided that multiple issuers offer short-term plans in their area and they meet the health requirements.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage for some low-income people, families, children, pregnant women, the elderly, and people with disabilities. There is no limited enrollment period for either Medicaid or CHIP, and you can apply at any time of the year.
To apply for Medicaid and CHIP, you need to create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for either program, your information will be sent to your state agency, and they will contact you about enrollment. The requirements for Medicaid and CHIP vary from state to state, so it is important to check with your state's Medicaid agency to learn about the specific documentation they require.
Medicaid may be able to help you pay for medical care received in the last three months, even if you were not enrolled in Medicaid at the time. However, payment depends on your family's income at the time. Some Medicaid programs pay for your care directly, while others use private insurance companies to provide coverage.
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women. CHIP beneficiaries must meet certain financial and non-financial criteria, including residency in the state where they are receiving CHIP and citizenship or qualified non-citizen status.
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Frequently asked questions
You may qualify for a Special Enrollment Period if you have experienced certain life events, such as getting married, having a baby, moving, or losing your health coverage. You can also qualify based on your income.
A Special Enrollment Period is a period of time outside of the Open Enrollment Period when you can enroll in or change your health insurance plan.
Special Enrollment Periods typically last for 60 days after the date of your qualifying event.
Examples of qualifying life events include getting married, having a baby, losing your job, or losing your health coverage.
If you don't qualify for a Special Enrollment Period, you may consider a short-term health plan or a health care sharing ministry plan. These plans are typically not as comprehensive as ACA-regulated policies but can provide some coverage while you wait for the next Open Enrollment Period.
