In some state-run exchanges, pregnancy is a qualifying life event

In most states, pregnancy does not trigger a special enrollment period to sign up for health insurance outside of the annual open enrollment period. HHS considered that possibility, but clarified in 2015 that it had opted not to include pregnancy as a qualifying life event. (The birth of the baby is a qualifying life event in every state, but that special enrollment period doesn't begin until the baby is born, meaning that the new health plan will not cover costs related to the pregnancy.)

However, state-run exchanges (there are 21 of them as of 2026) have some flexibility to set their own rules for qualifying life events and special enrollment periods. And more than half of the state-run exchanges have chosen to allow a special enrollment period triggered by pregnancy.

This makes the pregnant person eligible to enroll in health coverage and have better access to prenatal care as well as coverage for labor and delivery costs. (In most cases, this special enrollment period applies to people who don't already have coverage, as opposed to an opportunity to change plans, but the specific rules vary from one state to another.)

States that have unsuccessfully considered legislation to create a pregnancy SEP

California's legislature passed a bill in 2025 that would have made pregnancy a qualifying life event starting in 2026,¹⁷ but Governor Newsom vetoed it. His reasons for the veto included increased costs as well as a “dangerous precedent for condition-specific special enrollment periods,” noting that it could destabilize the individual market if the door were to be opened to allowing people to enroll in coverage due to a new need for medical care.¹⁸

Similarly, legislation to create a special enrollment period due to pregnancy (including for state-regulated employer-sponsored plans) passed in Nevada in 2025, but was vetoed by the governor.¹⁹ (The Nevada bill also included new coverage mandates for IVF, the cost of which was the focus of Gov. Lombardo's veto.)²⁰

Legislation introduced in New Mexico in 2025 and 2026 would have created a pregnancy SEP for uninsured individuals, in both the individual and group market. But the measures did not advance.²¹

Several pieces of legislation were introduced in 2024 in Kentucky that would have created a special enrollment period triggered by pregnancy, but none of them were successful.²²

In 2023, the state legislatures in Kentucky (H.B.286) and in Massachusetts (H.1052) considered creating special enrollment periods triggered by pregnancy, but neither bill was successful during the 2023 legislative session.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.