Guide to special enrollment periods

special-enrollment-guide

In this guide

What is a special enrollment period?
How long are special enrollment periods?
Qualifying life events that trigger a special enrollment period
Frequently asked questions about special enrollment periods and qualifying life events

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.

Have a qualifying life event?

See what kind of ACA compliant coverage is available outside of open enrollment. Compare health plans and check available subsidy savings with the help of a licensed agent.

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 (or 90 days in most states if the qualifying event is the loss of Medicaid²).

However, in the case of involuntary loss of coverage, the non-calendar-year renewal of an existing health plan, or advance notice of an ICHRA or QSEHRA offer from your employer, the special enrollment period begins 60 days before the qualifying event, allowing for seamless coverage.

In most cases, the earliest that coverage can take effect is the first of the month after the enrollment is completed, although retroactive coverage is available in the case of a new baby or newly adopted child.