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A special enrollment period is when you can join an Affordable Care Act (ACA) insurance plan outside regular open enrollment, which typically runs from Nov. 1 through Dec. 15.
To qualify for special enrollment, you must be experiencing a life event such as getting married or losing employer coverage. You generally need to select a health insurance marketplace plan within 60 days of your life event.
How do I qualify for a special enrollment period?
Several life changes allow for a special enrollment period. It's important to understand how and when you qualify, enroll and apply. If you supply all the needed information before the deadline, you typically can avoid a gap in coverage and the potential for costly medical bills.
Events that allow for a special enrollment period fall into six main groups:
Qualifiers for Special Enrollment Periods
Not all special enrollment periods require paperwork to prove that you're eligible. You will learn during the application process whether you need to send documents, but where possible we've listed records you may be asked to provide.
With most special enrollment periods, you must apply within 60 days of a qualifying life event. Coverage generally starts the first of the month after choosing a marketplace plan, as long as you've paid the premium.
Your family makeup changes
This special enrollment period applies when you need to add new family members to your plan or you lose coverage due to a death or divorce. When you have a baby or adopt or foster a child, you can retroactively begin coverage the day of the event, so long as you enroll within 60 days afterward.
|Getting married||Provide a marriage certificate or license showing the spouses' names and the date of marriage|
|Having a baby, adopting a child or placing a child for foster care||For adoption or a foster care placement, supply adoption letters or records, court orders or foster care papers|
|Divorce or legal separation causing a loss of health insurance||The divorce or separation must result in loss of coverage|
|Losing coverage due to a death||Occurs when you lose eligibility for your current marketplace plan due to the death of someone on that plan|
You move to the U.S. or relocate within the U.S.
Several moving scenarios qualify you for a special enrollment period — even moving to a new ZIP code or county is enough justification to select a new health plan.
If you moved within the U.S., you must provide proof that you relocated in the last 60 days and that you had health coverage for at least one day during the 60 days before your move.
If you moved to the U.S. from a foreign country you must show proof of your move, but you don't need to verify prior health coverage.
These moves qualify for this special enrollment period:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or a United States territory
- If you're a student, moving to or from the place you attend school
- If you're a seasonal worker, moving to or from the place you both live and work
- Moving to or from a shelter or other transitional housing
You lose other health insurance
When you apply for a special enrollment period because of losing your insurance, you must pick a plan through the Health Insurance Marketplace within 60 days before or after the date you lose coverage. Once you choose a plan, you have 30 days to supply documents showing when your plan expired.
Requirements or triggering events
|Losing job-based or family coverage|
|Losing an individual health policy you bought yourself|
|Losing eligibility for Medicaid or Children's Health Insurance Program (CHIP) coverage|
|Losing eligibility for Medicare||You become ineligible for premium-free Medicare Part A ?|
|Losing COBRA coverage|
You experience other life changes
You may qualify for a special enrollment period if you encounter other life changes such as becoming a U.S. citizen or leaving a correctional facility. You must apply within 60 days of the event and may need to send proof of your eligibility.
|Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) shareholder|
|Becoming a U.S. citizen|
|Starting or ending service as an AmeriCorps, VISTA or NCCC member|
You encounter another less-common scenario
You may qualify for a special enrollment period in complex situations that prevent or delay you from applying during an open enrollment period. For example, you may have encountered a natural disaster or had technical issues with the HealthCare.gov website.
What to know
|Enrollment, plan information or display errors|
|Being denied enrollment in Medicaid or CHIP|
|You experienced domestic abuse or violence or spousal abandonment|
|You are denied coverage, file an appeal and are then approved for enrollment|
Your employer-sponsored insurance becomes too costly or no longer provides minimum coverage
You qualify for this special enrollment if your premium is more than 9.61% of your household income or the plan pays less than 60% of covered medical costs (meaning it's not providing minimum coverage). You also must be otherwise eligible for subsidies in the exchange based on your income.
The premium requirement refers only to the portion of employer coverage you pay for yourself, not what you pay for your family members.
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How do I apply for a special enrollment period?
You apply for coverage during a special enrollment period much like you would during open enrollment. To start the process, create an online account through a health insurance marketplace When you apply for special enrollment, you must provide the specific reason you qualify. HealthCare.gov will review your application and let you know whether you need to send documents to prove your eligibility.
If your qualifying event happens to occur during open enrollment, you can apply during that period without the need to submit proof of your status. Open enrollment dates don't often change, but be sure to apply within the deadline for the upcoming calendar year.
When should I apply?
You typically have 60 days after a qualifying event to apply for coverage. In some cases, you can apply up to 60 days before an expected event occurs, such as losing health insurance when you quit your job. Submitting your application within the required time limit helps to avoid gaps in your health care coverage. After you pick a plan, you have 30 days to send any required documents.
Is any documentation required?
After submitting your application, you'll receive an eligibility notice letting you know whether documents are needed and when you must send them. If your eligibility notice doesn't say you must submit any records, then you don't need to do so.
If your eligibility notice includes a request for documents, send them as soon as possible after you pick a plan to prevent a delay in coverage. The quickest method is to upload the documents to your HealthCare.gov account. You also can mail copies to:
- Health Insurance Marketplace
- Attn: Supporting Documentation
- 465 Industrial Blvd.
- London, KY 40750-0001
What happens after I apply?
If your request is approved, HealthCare.gov will send a confirmation to the insurance plan you choose. Your coverage won’t start until you pay your first premium, so send that payment as soon as you can.
Your coverage start date is normally the first of the month after you pick a plan and are approved. But you can’t use your coverage until you're approved and you make your first payment.
If HealthCare.gov can't confirm your special enrollment period using the documents you provide, the agency will send you a letter of explanation or add a notice to your marketplace account. You can upload the needed documents or let HealthCare.gov know in writing why you can't provide them.
What do I do if my special enrollment request is denied?
If you think your special enrollment period was denied in error, you can file an appeal. If your enrollment is approved based on the appeal, you can get coverage back to the date your special enrollment period was first denied.
To file an appeal, select your state’s form from the HealthCare.gov appeals page.
You can either complete and submit the form online or fill out a printed version and mail it to:
- Health Insurance Marketplace
- Attn: Appeals
- 465 Industrial Blvd.
- London, KY 40750-0061
Although not required, you can attach a copy of the eligibility denial or other official notice you received to help with processing.
Frequently asked questions
How long is the ACA special enrollment period?
Most special enrollment periods last 60 days. You must apply for a plan through a state or federal marketplace within 60 days of experiencing a life event. With some special enrollment periods, such as losing health coverage on your 26th birthday, you can start the process up to 60 days before the date your event will occur.
What happens if I miss the special enrollment period?
If you missed a special enrollment period and don't qualify for another one, check income-based plans like Medicaid and CHIP, which you can apply for at any time. Otherwise, you'll need to wait for the next open enrollment period to sign up for a marketplace health plan.
Is there a special enrollment period for Medicaid or CHIP?
There is no special enrollment period for Medicaid or CHIP — you can apply for either program at any time of year. If you need health coverage and think you might be eligible, you should apply as soon as possible. To qualify, you need to meet income or health-related requirements set by your state or the federal government.
What is the difference between open enrollment and special enrollment?
Open enrollment is the annual period when you sign up for ACA health insurance or change your existing plan. It's available to anyone and usually runs from Nov. 1 to Dec. 15 of each year. Special enrollment allows you to sign up for health insurance at any time of year, but you must qualify based on a specific life event.
Information on special enrollment options, eligibility and application requirements was obtained directly from CMS.gov and HealthCare.gov. Medicaid and CHIP information also was sourced from HealthCare.gov.