What is a Special Enrollment Period?

The only time you can enroll in a health insurance plan in the Health Insurance Marketplace (commonly referred to as “Obamacare”) is during the Open Enrollment Period each year, which ends on January 15.

After that, the only way you can enroll in a plan is if you qualify for a “Special Enrollment Period.”

How Do You Qualify for a Special Enrollment Period?

I’m glad you asked!

You qualify for a special enrollment period through a major life event. Qualifying events include:

  • Loss of qualifying coverage. For example, if you lost job-based health insurance or aged off your parents’ plan, you’d have a 60-day window during which you could choose a new plan on the Marketplace. (Note – this is not available if you lost qualifying coverage because you didn’t pay your bills!).
  • Change in household size. Think marriage, childbirth, divorce.
  • Change in primary place of living. This change has to result in access to new or different plans – so moving across the street doesn’t count, but moving to a new state does.

There are other events that could result in a Special Enrollment Period, but these are the most common ones.

Who Always Has a Special Enrollment Period?

There is a smaller set of people who basically always qualify for a Special Enrollment Period.

If you make between 100-150% of the Federal Poverty Level, you can enroll in or change plans at any point in the year. The Federal Poverty Level is based on your household size (i.e. the number of people on your tax return). If you aren’t sure, just contact us and we’ll help you figure it out. As of this writing, this rule is in place until December 31, 2025.

Additionally, Consumers who are members of a federally recognized Indian tribe or Alaska Native Claims Settlement Act Corporation shareholders can sign up for or change plans once per month throughout the year.

Need Help with Special Enrollment Periods?

We’re happy to help you figure out if you qualify and find the right plan if you do.

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