If I enroll in the exchange, will that coverage take effect immediately?

Q: If I enroll in the exchanges, will that coverage take effect immediately? What’s the earliest my coverage will take effect after I complete the enrollment process?

A: No, it will not take effect immediately. Your coverage effective date mostly depends on the date that you enroll, although there are some qualifying events that allow for effective dates that differ from the regular schedule.

But the regular schedule in all but two states works like this:

  • If you enroll by the 15th of the month, your coverage will take effect the first of the following month.
  • If you enroll between the 16th and the end of the month, your coverage will take effect the first of the second following month.

So an enrollment completed on May 9 would have a June 1 effective date, but an enrollment completed on May 17 would have a July 1 effective date.

Two states with different rules

There are two states — Massachusetts and Rhode Island — where the exchanges allow people to enroll as late as the 23rd of the month and still have a first of the following month effective date. So May 17 enrollment in one of those states would result in a June 1 effective date (but a May 24 enrollment would result in a July 1 effective date). Washington used to have a 23rd of the month deadline as well, but they changed that in 2017, and now use the same 15th of the month enrollment deadline that’s used in most other states.

Qualifying events with different effective date rules

If you’re enrolling during a special enrollment period triggered by a qualifying event, effective dates mostly still follow the same schedule outlined above. But if you get married, you’re eligible to get coverage effective the first of the following month, regardless of how late in the month you enroll. And if you have a baby, adopt a child, or receive a court order for medical child support, the coverage can be backdated to the date of the birth, adoption, or court order. Loss of other coverage is a qualifying event that also allows for different effective date rules — if you enroll before your old plan ends, you can enroll up until the last day of the month and your new plan will take effect the first of the following month.

2019 open enrollment

Open enrollment for 2019 coverage will begin on November 1, 2018, and the first available effective date (even for people who sign up on November 1, 2018) will be January 1, 2019. In almost all states, this will be the only available effective date, as open enrollment will end on December 15, 2018, which will be the last day to select a plan for 2019.

But California has enacted legislation that establishes a three-month open enrollment period going forward. It will begin on October 15 each year, and continue until January 15. Enrollments completed in California between October 15, 2018 and December 15, 2018 will have coverage effective January 1, 2019. Enrollments completed between December 16, 2018 and January 15, 2019 will have coverage effective February 1, 2019.

In addition, if any insurers exit the market or terminate certain plans (replacing PPOs with HMOs, for example) at the end of 2018, the people enrolled in those plans will be eligible for special enrollment periods. The special enrollment period, in that case, will run for 60 days before and 60 days after the loss of coverage. So if your plan is terminated at the end of 2018, you’ll be able to enroll in a new plan after December 15. If you pick a replacement plan before the end of December, you’ll have coverage effective January 1. If you pick a replacement plan in the first 60 days of 2019, your new plan will take effect either the month after you enroll or the month after that, depending on the date you enroll.

Outside the exchanges, effective dates generally follow the same rules as inside the exchanges.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.