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Many people assume they can only sign up for health insurance during the Open Enrollment period. But life doesn’t always stick to a schedule. Events like losing a job, welcoming a new child, or experiencing another major change can happen at any time. When they do, you may still have the opportunity to get covered through a Special Enrollment Period (SEP).
What Is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a limited time outside of Open Enrollment when you can sign up for a Marketplace health plan or make changes to your current one. To qualify, you must experience a qualifying life event that affects your coverage needs.
Knowing how SEPs work can help you avoid gaps in your insurance and stay prepared throughout the year. Most SEPs last about 60 days from the date of the event, so understanding the rules ahead of time makes it easier to secure the coverage that protects your health and your budget.
How Does a Special Enrollment Period Work?
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The 60-Day Rule: For most life changes, you have 60 days from the date of the event to enroll in a plan.
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Advance Enrollment: For certain events, like losing job-based coverage or receiving an employer HRA offer, you can apply up to 60 days before the change occurs to prevent a gap in coverage.
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Medicaid and CHIP Timing: If you lose Medicaid or Children’s Health Insurance Program (CHIP) coverage, you have a longer window of 90 days to enroll in a Marketplace plan.
Qualifying Life Events (QLEs): Who Can Apply?
Certain life changes can make you eligible for a Special Enrollment Period, allowing you to enroll in or update your Marketplace coverage outside the annual Open Enrollment window. According to HealthCare.gov, several key categories of qualifying life events may trigger a SEP, each tied to a significant shift in your circumstances.
1. Loss of Health Coverage
Losing qualifying health coverage is one of the most common reasons people become eligible for a Special Enrollment Period. You may qualify if you’ve lost coverage within the past 60 days or expect to lose it in the next 60 days. Common examples include:
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Job-based coverage: Losing insurance through your employer or a family member’s employer, or aging out of a parent’s plan when you turn 26.
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Individual plans: Losing coverage because your plan is discontinued, you’re no longer eligible for a student health plan, or you move outside your plan’s service area.
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Government Programs: Losing eligibility for Medicaid, CHIP, or premium‑free Medicare Part A.
Note: You won’t qualify for a SEP if you lose coverage due to unpaid premiums or failing to submit required documentation.
2. Changes in Household
Certain household changes occurring within the past 60 days may qualify you for a Special Enrollment Period. These events often affect your coverage needs and can open a window to update or choose a new Marketplace plan.
Marriage: If you get married, you may qualify for a SEP. When you select a plan by the last day of the month, your coverage can begin on the first day of the following month.
Growing your family: Welcoming a new child, whether through birth, adoption, or foster placement, qualifies you for immediate coverage. In most cases, coverage can start on the day the event occurs.
Divorce or legal separation: This qualifies only if the separation results in the loss of health insurance. If your coverage remains unchanged, a SEP may not apply.
Death: If someone on your Marketplace plan passes away and their death causes you to lose your current coverage, you may be eligible for a SEP.
3. Changes in Residence
A move to a new home can qualify you for a Special Enrollment Period, but only under certain circumstances. You may be eligible if you move to:
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A new ZIP code or county.
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The U.S. from a foreign country or U.S. territory.
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A transitional housing location or shelter.
Note: To qualify, you generally must show that you had qualifying health coverage for at least one day during the 60 days before your move. This rule does not apply if you’re moving from a foreign country or U.S. territory. Moves made solely for vacation or medical treatment do not qualify.
4. Other Qualifying Events
Several other life events may open a Special Enrollment Period and allow you to update or choose new Marketplace coverage. These situations vary, but they all involve a significant shift in your circumstances.
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Financial Changes: A notable decrease in household income can make you newly eligible for savings on a Marketplace plan, even if you weren’t eligible before. Please note that a change in income may NOT always trigger a special enrollment period.
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Status Changes: Certain changes in legal or personal status can qualify you for a SEP. This includes gaining U.S. citizenship, being released from incarceration, or becoming a member of a federally recognized tribe.
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Employer Offers: If your employer begins offering an Individual Coverage Health Reimbursement Arrangement (HRA) or a Qualified Small Employer HRA (QSEHRA), you may be eligible to enroll in Marketplace coverage or update your existing plan.
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Service & Disasters: Life events connected to national service or unexpected emergencies can also qualify. This includes starting or completing AmeriCorps service, or being impacted by a natural disaster such as a hurricane, wildfire, or flood.
Enrollment Timelines
| Event Type | Enrollment Window | Coverage Start Date |
| Birth / Adoption | 60 days after | Day of the event |
| Marriage | 60 days after | First day of next month |
| Loss of Job-Based Plan | 60 days before or after | Varies |
| Loss of Medicaid / CHIP | 90 days after | Varies |
| Move to U.S. | 60 days after | Varies |
How to Apply for an SEP
Applying for a Special Enrollment Period is a straightforward process, but it’s important to follow each step carefully to ensure your coverage starts on time.
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Check Eligibility: Start by confirming that your recent life change qualifies as a recognized SEP event. This could include income changes, household changes, or other qualifying circumstances. You can give us a call, and we can help you with this step.
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Select a Plan: Once you’re deemed eligible, review the available Marketplace plans and choose the one that best fits your health and budget needs.
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Provide Documentation: Some qualifying events require proof, such as a marriage certificate, birth notice, or other official documents. You’ll also need to attest that all information you provide is accurate. In some instances, you may have up to 60 days to provide the necessary documentation.
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Confirm and Pay: For certain events, including HRA-related enrollments, finalizing your coverage may require contacting the Marketplace Call Center. Your coverage typically begins only after your first premium payment is submitted.
Final Thoughts
A Special Enrollment Period is an important option for anyone experiencing a major life change outside the regular Open Enrollment period. Whether you are expanding your household, moving to a new location, or losing your previous coverage, these enrollment windows give you a chance to find the health insurance you need without waiting for the next enrollment cycle. If you have any questions, our team of licensed agents is here to help you every step of the way. Click here to request additional information.
Have Health Insurance Questions?
We hope this information helps you understand “What is a Special Enrollment Period?” and that it was useful to you.
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