Who doesn’t need a qualifying life event to enroll in health insurance outside of open enrollment?

If you need to obtain your own health insurance (i.e., not through your employer), you’re probably familiar by now with the fact that the individual health insurance market has an annual open enrollment period. To enroll outside of open enrollment, most applicants will need a qualifying life event to trigger a special enrollment period (SEP).

But qualifying events aren’t always necessary to trigger an SEP. Enrollment continues year-round in some cases, and you don’t need a qualifying event if you’re in one of these categories:

• American Indians and Alaska Natives. The Affordable Care Act (ACA) has a provision that allows American Indians and Alaska Natives to enroll year-round in the exchanges. They also have access to plans with zero cost-sharing if their income is no more than 300% of the federal poverty level. Starting in 2018,¹ HHS added a provision to ensure that dependents of American Indians can enroll on the same application as the American Indian.²
• In nearly every state, low-income people who are eligible for premium subsidies (i.e., they aren’t eligible for Medicaid or in the coverage gap) and whose income doesn’t exceed 150% of the poverty level can enroll at any time. But this enrollment opportunity will not be available from August 25, 2025 through the end of 2026, due to a rule change that HHS finalized in 2025.³
• Residents of Massachusetts who qualify for ConnectorCare, as long as they are either newly eligible for ConnectorCare, or are applying for the first time. (The ability to enroll year-round in ConnectorCare does have some restrictions). ConnectorCare is available to residents with income up to 500% of the federal poverty level (through 2026; the limit is scheduled to drop to 300% starting in 2027, unless the higher limit is extended again). The program is subsidized by the state, in addition to the premium subsidies and cost-sharing subsidies provided by the ACA.⁴
• Residents of Connecticut who are eligible for the Covered Connecticut program. This includes adults under age 65 who are not eligible for Medicaid and whose income doesn’t exceed 175% of the poverty level. Enrollees must select a Silver-level plan through the Connecticut Marketplace (Access Health CT) and utilize all available federal subsidies.⁵

Basic Health Programs

Minnesota and Oregon both offer Basic Health Programs (BHPs), with enrollment available year-round to eligible applicants. New York has a similar program, which used to be a BHP but is now operating as a different program with a higher income limit.⁶ Here are the details:

• Residents of Minnesota who are eligible for MinnesotaCare can enroll in that coverage year-round. The program is open to those who aren't Medicaid-eligible, and the upper income limit is 200% of the federal poverty level. Enrollment continues year-round.
• Residents of Oregon who are eligible for Oregon Health Plan Bridge can enroll in that coverage year-round. Enrollment is available for people who aren't eligible for Medicaid and whose household income isn't more than 200% of FPL.
• Residents of New York who are eligible for The Essential Plan can also enroll year-round. This program is available for residents who are not eligible for Medicaid or CHIP, and whose annual household income is up to 250% of the federal poverty level (FPL). 

Medicaid/CHIP

A qualifying event is also not necessary to enroll in  Medicaid or the Children’s Health Insurance Program (CHIP). Enrollment in these plans is available year-round, both for people who are newly eligible due to a change in income, and for people who were already eligible but not yet enrolled.

For everyone else shopping for their own ACA-compliant individual/family health insurance – on-exchange or off-exchange – a qualifying event will be necessary to buy a plan outside of open enrollment.

Qualifying events are not necessary to enroll in plans that aren’t subject to ACA regulations, including accident supplements, critical illness plans, short-term health plans, travel insurance, fixed indemnity plans, and other limited benefit plans. So those plans can be purchased at any time during the year, as long as the applicant is eligible based on the insurer’s underwriting rules. But these plans are not suitable to serve as a person's only coverage, so they should generally only be used in conjunction with an ACA-compliant major medical plan, or to bridge a short coverage gap while waiting for open enrollment or a special enrollment period.

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.