What happened to ACA’s low-income special enrollment period?

What was the special enrollment period for individuals with income up to 150% of the federal poverty level?

In September 2021, the U.S. Department of Health and Human Services (HHS) finalized a new special enrollment period (SEP) that made an individual eligible for year-round enrollment in ACA-compliant health insurance if the applicant’s household income did not exceed 150% of the federal poverty level (FPL) and if the applicant was eligible for a premium tax credit (subsidy).

The low-income SEP was available for plan buyers in states that use HealthCare.gov and was optional for states that operate a state-based exchange – although most of the exchanges offered the SEP.

This SEP was initially slated to be available for as long as the American Rescue Plan’s (ARP) subsidy enhancements were available. (These subsidy enhancements result in a $0 premium benchmark plan for applicants with income up to 150% of the federal poverty level, but the subsidy enhancements will expire at the end of 2025 unless Congress takes action to extend them.)

HHS subsequently finalized a rule change in April 2024, making the low-income SEP permanently available, regardless of whether the ARP subsidy enhancements are extended.¹

However, additional rule changes and legislation have since eliminated the low-income SEP, nationwide:

• In June 2025, HHS finalized a rule change that temporarily eliminates the low-income SEP nationwide from August 25, 2025 through the end of 2026.²
• Then in July 2025, the “One Big Beautiful Bill Act” (OBBBA) was enacted, adding new restrictions. Under the terms of the OBBBA, Marketplace subsidies will no longer be available, starting in 2026, for anyone who enrolls during an income-based special enrollment period that isn’t tied to a qualifying life event.³

The OBBBA provision is permanent, so it essentially results in the low-income SEP being permanently eliminated. This is because if an exchange were to make that SEP available again in 2027 or a future year, a person using it wouldn’t be eligible for subsidies (since this SEP is based on household income relative to the poverty level, without a specific qualifying life event, and OBBBA prohibits subsidies when that type of SEP is used). Full-price (unsubsidized) coverage would likely be unaffordable for anyone earning no more than 150% of FPL.)

What did this special enrollment period allow eligible applicants to do?

Under this special enrollment period, eligible applicants (meaning those who were subsidy-eligible and had household income up to 150% of FPL) could enroll in an ACA-compliant health plan through the Marketplace at any time during the year, with coverage taking effect on the first of the following month. (Again, this opportunity is no longer available as of August 25, 2025).⁴

This special enrollment period did not have limitations on how often it could be used, or the type of health plan an applicant could select.

A person with an eligible household income who was already enrolled in an exchange plan could use the low-income SEP to pick a different plan, although deductible and out-of-pocket spending would reset to $0 for the year when the new plan starts. (State-run exchanges could choose to limit this SEP only to people who aren't already enrolled, or to make it available to both new and current enrollees.)

Will people who were eligible for the low-income SEP still be eligible for premium subsidies and / or cost-sharing subsidies?

Yes, these individuals can still qualify for income-based subsidies. But they can only enroll in Marketplace coverage (with or without subsidies) during the annual open enrollment period, or during a special enrollment period. And the special enrollment period that was specifically linked to having a low income is no longer available.

Are any states providing their own version of a low-income SEP?

Under the Marketplace rule that was finalized in June 2025, state-run exchanges had to stop offering the low-income SEP starting August 25, 2025.²

But Medicaid is available year-round to eligible applicants.⁵ And there are a few states that offer year-round enrollment in other programs that have income limits that extend above the standard Medicaid expansion income limit (138% of FPL). They include:

• Oregon and Minnesota, which have Basic Health Programs (BHPs) that offer year-round enrollment for people with income up to 200% of FPL. (Washington, DC plans to join this list as of January 2026.⁶ DC currently offers Medicaid up to 215% of FPL, but will reduce that limit to 138% of FPL starting in January 2026, and add a BHP to cover those with income up to 200% of FPL.)⁷
• New York, which has a program that used to be a BHP but that now has an income limit of 250% of FPL.⁸ Enrollment continues to be available year-round.).⁹ New York plans to revert to a BHP, with an income limit of 200% of FPL, in July 2026.¹⁰
• Massachusetts, which offers Connector Care to people with income up to 500% of FPL. (Enrollment is open year-round to people who are newly eligible or who have not been covered under the program in the past.)¹¹ The year-round SEP is available to ConnectorCare enrollees with income up to 150% FPL, even if they’re not newly-eligible and/or have previously been covered under the program.)
• Connecticut, which offers Covered Connecticut to adults with income up to 175% FPL.¹²
  

What can someone do if they no longer have access to the low-income SEP?

Low-income enrollees should make sure they take advantage of the annual open enrollment period to sign up for coverage. Even if the subsidy enhancements are not extended past the end of 2025, significant subsidies will continue to be available to people with income up to 150% of FPL.

And although year-round enrollment is no longer an option, other SEPs continue to be available based on qualifying life events such as losing other coverage. It’s important to pay close attention to the deadlines for these SEPs, as they generally only last for 60 days following the qualifying life event.¹³