Find a plan.
A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Call our agency partners 866-553-3223

Featured

Featured
13 qualifying life events that trigger ACA special enrollment
Outside of open enrollment, a special enrollment period allows you to enroll in an ACA-compliant plan (on or off-exchange) if you experience a qualifying life event.

Latest News & Topics

Latest News & Topics

Featured

Featured
Finalized federal rule reduces total duration of short-term health plans to 4 months
A finalized federal rule will impose new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The rule – which applies to plans sold or issued on or after September 1, 2024 – will limit STLDI plans to three-month terms, and to total duration – including renewals – of no more than four months.
Call our agency partners 866-553-3223

Guide to special enrollment periods

special-enrollment-guide

special-enrollment-guide

Not everyone who’s eligible to enroll in ACA-compliant health insurance bought coverage during the most recent open enrollment period.1 Some people may have missed the annual enrollment deadline. Others may have decided that coverage was too expensive – perhaps unaware that they were eligible for premium subsidies if they enrolled on the Marketplace. Others may have felt they didn’t have enough information to make a decision.

But depending on the circumstances, many people can still enroll in ACA-compliant health coverage – even after the annual open enrollment period has ended – during a special enrollment period. There’s a lengthy list of qualifying life events that make consumers eligible for special enrollment, and this guide will walk you through all the qualifying life events and the specific rules for how they trigger special enrollment periods.


What is a special enrollment period?

Normally, ACA-compliant coverage is only available for purchase during the annual open enrollment period, but a special enrollment period allows people to sign up for coverage outside of that annual window. In most cases, this requires a qualifying life event.

In many cases, a special enrollment period is only available if an applicant already had minimum essential coverage prior to the qualifying life event. Other restrictions prevent people from using special enrollment periods (SEPs) to upgrade to better coverage during the year, though some of those restrictions have been relaxed in recent years.

During most SEPs, an individual (and dependents) can enroll in any health plan available in their Marketplace / exchange, although some SEPs limit current enrollees to a replacement plan at the same metal level as their current coverage. Most of the SEPs also apply to health plans available outside the exchange, giving people an option to pick off-exchange coverage if that’s their preference.


How long are special enrollment periods?

Most of the qualifying life events trigger a special enrollment period that begins on the date of the qualifying life event and continues for 60 days. In most cases, the earliest that coverage can take effect is the first of the month after the special enrollment is completed.

However, in the case of involuntary loss of coverage, the special enrollment period begins in advance of the loss of coverage so that enrollees can purchase a new plan with no gap in coverage.


Qualifying life events that trigger special enrollment

tab-content-image-mobile
tab-content-image
tab-content-image-mobile
tab-content-image
tab-content-image-mobile
tab-content-image
tab-content-image-mobile
tab-content-image


Footnotes

  1. Key Facts about the Uninsured Population” KFF.org, December 2023