Special Enrollment Periods: When You Can Sign Up Outside Open Enrollment

Missed Open Enrollment? Lost your job in March? Had a baby in July? Got divorced in October?

You're not stuck waiting until November.

One of the most common misconceptions about ACA health coverage is that you can only sign up during Open Enrollment (November 1 - January 15 in most states). The reality is much more flexible: Special Enrollment Periods (SEPs) let millions of Americans enroll outside the main window when qualifying life events occur.

This guide covers every qualifying event, how long you have to enroll, and exactly how to use your Special Enrollment Period.

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What Is a Special Enrollment Period?

A Special Enrollment Period is a window of time — usually 60 days — when you can enroll in health coverage outside of Open Enrollment due to a qualifying life change.

During an SEP: - You have full access to all marketplace plans in your area - You qualify for the same subsidies as during Open Enrollment - You can change plans if you already have coverage (in some cases) - Coverage can start as soon as the first of the following month

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The Major Qualifying Events

Loss of Coverage

You qualify if: - You lost job-based health coverage (quit, fired, laid off, hours reduced) - You lost Medicaid or CHIP eligibility - You aged off a parent's plan (at 26) - Your COBRA coverage is ending - You lost coverage through a family member's plan - A plan you were enrolled in is discontinued - Your coverage is ending for any reason other than non-payment

Important notes: - Coverage ending must be involuntary (you can't just cancel your plan to trigger an SEP) - You can enroll 60 days BEFORE or 60 days AFTER coverage ends - Don't wait until you're already uninsured — you can apply as soon as you know coverage is ending

Documentation needed: Letter from employer, termination notice, or proof of coverage end date

Moving to a New Area

You qualify if: - You moved to a new zip code or county - You moved to the U.S. from another country - You're moving in a way that changes your available plans

Important notes: - Temporary moves don't count (vacation, business travel) - The move must affect which plans are available to you - You have 60 days from the move date to enroll

Documentation needed: Proof of new address (lease, utility bill, change of address confirmation)

Family Changes

You qualify if: - You got married - You had a baby or adopted a child - You placed a child for adoption or foster care - You got divorced - A dependent died

Important notes: - Marriage allows both spouses to enroll or change plans - Adding a baby requires updating your plan (child can be added retroactive to birth) - Divorce that results in loss of coverage triggers an SEP

Documentation needed: Marriage certificate, birth certificate, adoption papers, divorce decree

Changes in Household

You qualify if: - A dependent moved into your household - A dependent left your household - Someone in your household died - A court ordered you to provide coverage for someone

Documentation needed: Varies by situation — proof of relationship, court order, etc.

Changes in Income or Status

You qualify if: - Your income dropped below 150% FPL (special SEP for newly lower-income individuals) - You lost your immigration status that made you ineligible - You gained citizenship or lawful presence - You were released from incarceration - A member of your household gained or lost employer coverage

Important notes: - Income changes above 150% FPL don't trigger SEPs (just subsidy adjustments) - Immigration status changes require documentation

Documentation needed: Income verification, immigration documents, release papers

Other Qualifying Events

You qualify if: - You experienced domestic abuse or spousal abandonment - Your plan violated a material provision of the contract - The marketplace or your insurance company made an error - You were affected by a disaster or emergency (FEMA-declared) - You are a Native American or Alaska Native (can enroll monthly) - You are a member of a federally recognized tribe - You missed enrollment due to misleading information from an enrollment assister

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Special Situations

Lost Medicaid Coverage

This is currently one of the largest SEP-eligible populations. If you were disenrolled from Medicaid: - You have 60 days from your Medicaid end date to enroll - You likely qualify for substantial marketplace subsidies - You may qualify for Cost-Sharing Reductions if income is under 250% FPL

Given the Medicaid unwinding (25 million people disenrolled), this SEP is affecting millions of Americans.

COBRA Ending

COBRA allows you to keep employer coverage temporarily, but it's expensive (you pay the full premium plus up to 2% administrative fee). When COBRA ends: - You have an SEP to enroll in marketplace coverage - You can also enroll BEFORE COBRA ends if you choose - Voluntarily ending COBRA also triggers an SEP (unlike regular employer coverage)

Turning 26

When you age off a parent's plan at 26: - You have 60 days to enroll in your own coverage - If you're employed, you may have access to employer coverage - If not, the marketplace is your option

Pro tip: Start your marketplace application a few weeks before your birthday so coverage can begin on the 1st of the month you turn 26.

Getting Married

Marriage opens an SEP for both spouses: - You can both enroll in new plans - You can combine onto one family plan - You have 60 days from the marriage date

Note: Living together without marriage does not trigger an SEP.

Having a Baby

Having or adopting a child triggers an SEP: - You can add the child to your existing plan - Coverage for newborns can be retroactive to birth - You can also change plans entirely during this SEP

Important: Report the birth/adoption within 60 days to ensure continuous coverage.

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How Long Does an SEP Last?

Most SEPs give you 60 days from the qualifying event to enroll.

Some exceptions: - Native Americans/Alaska Natives: Monthly enrollment opportunities - Certain low-income SEPs: 60 days - Error-based SEPs: May have extended timeframes - FEMA disaster declarations: Typically extended deadlines

Don't wait until day 59. Start your application as soon as you have documentation of your qualifying event.

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When Does Coverage Start?

Coverage start dates during SEPs depend on when you enroll:

If you select a plan...	Coverage starts...
Days 1-15 of a month	1st of following month
Days 16-31 of a month	1st of the month after next

Exception for birth/adoption: Coverage for a newborn or newly adopted child can be made retroactive to the date of birth/adoption.

Example: - You lose coverage February 28 - You complete enrollment March 10 - Coverage begins April 1

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How to Use Your SEP

Step 1: Gather Documentation

Before starting your application, have proof of your qualifying event ready: - Termination letter or coverage end date - Marriage certificate, birth certificate, or adoption papers - New address documentation - Medicaid termination notice - Any other relevant documents

Step 2: Start Your Application

1. Go to HealthCare.gov (or your state marketplace)
2. Log in or create an account
3. Start a new application (or update an existing one)

Step 3: Report the Qualifying Event

During the application: - You'll be asked about current coverage and recent changes - Select the qualifying event that applies to you - Enter the date of the event

Be accurate: The date you report determines your 60-day window.

Step 4: Verify Your SEP

The marketplace may ask you to verify your qualifying event: - You may be asked to upload documents - In some cases, you can self-attest (confirm without documents initially) - If you self-attest, keep documentation in case it's requested later

Step 5: Compare Plans and Enroll

Once your SEP is confirmed: - Browse all available plans - Compare premiums, deductibles, networks - Select a plan and complete enrollment

Step 6: Pay Your First Premium

Coverage doesn't start until you pay. Once enrolled: - You'll receive information about paying your first premium - Pay by the deadline to ensure coverage starts on time - Set up autopay to avoid future lapses

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What If You Don't Have a Qualifying Event?

If you missed Open Enrollment and don't have a qualifying event, your options are limited:

Check again for qualifying events: - Did your income drop below 150% FPL recently? - Did any household members gain or lose coverage? - Did you move in the past 60 days? - Are you Native American or Alaska Native?

Check Medicaid eligibility: - Medicaid enrollment is year-round - If your income is below 138% FPL (in expansion states), you may qualify - Apply through HealthCare.gov — it will determine if you qualify for Medicaid

Wait for Open Enrollment: - Open Enrollment 2025 runs November 1, 2025 - January 15, 2026 - Mark your calendar and don't miss it - Set up reminders for October

Other options (not recommended as primary coverage): - Short-term health plans (limited coverage, pre-existing condition exclusions) - Health sharing ministries (not insurance, no guarantees) - COBRA (if recently employed, but expensive)

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Common SEP Questions

"How do I prove I lost coverage?"

Request a letter from your former employer or insurance company stating: - Your name - The coverage that ended - The effective end date - That the termination was involuntary

Most employers will provide this automatically. If not, HR departments are accustomed to these requests.

"Can I change plans during an SEP?"

If you already have marketplace coverage and experience a qualifying event, you may be able to change plans — not just add or remove people. Review your specific situation during the application.

"What if I was enrolled without my consent?"

If you were fraudulently enrolled in a plan, you may qualify for an SEP based on "exceptional circumstances." Contact the marketplace at 1-800-318-2596 to explain your situation.

"Do I have to wait until my coverage ends?"

No! If you know coverage is ending (job loss, COBRA exhaustion, turning 26), you can enroll up to 60 days BEFORE the end date. This prevents any gap in coverage.

"What if I'm not sure I qualify?"

Start the application anyway. The marketplace will determine your eligibility. If you don't have a valid SEP, it will tell you. You won't be penalized for checking.

"My situation is complicated — where can I get help?"

• Navigators: Free, in-person help at LocalHelp.HealthCare.gov
• Marketplace call center: 1-800-318-2596 (24/7 during Open Enrollment, reduced hours otherwise)
• State consumer assistance programs: Many states have additional help available

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SEP Quick Reference

Qualifying Event	Time to Enroll	Documentation
Lost job-based coverage	60 days before or after	Termination letter
Lost Medicaid	60 days after	Termination notice
COBRA ending	60 days before or after	COBRA end notice
Turned 26	60 days before or after	Birth date confirmation
Got married	60 days after	Marriage certificate
Had/adopted baby	60 days after	Birth/adoption certificate
Got divorced	60 days after	Divorce decree
Moved	60 days after	Proof of address
Income dropped below 150% FPL	60 days after	Income documentation
Released from incarceration	60 days after	Release documents
Native American/Alaska Native	Any time	Tribal documentation

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Don't Wait Until You're Desperate

The biggest mistake people make with Special Enrollment Periods is waiting too long. The 60-day window seems like plenty of time — until it's not.

Best practice: - As soon as you know a qualifying event is happening, start your application - Don't wait until you're uninsured to act - Get coverage lined up so it starts when your old coverage ends - Keep documentation in a safe place

Health emergencies don't wait for convenient timing. An accident or illness during a coverage gap can be financially devastating. Use your SEP promptly.

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Ready to Check Your Options?

Not sure if your situation qualifies for a Special Enrollment Period? Our quiz can help you identify qualifying events and guide you through next steps.

[Check My SEP Eligibility →]

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This guide covers Special Enrollment Periods as of 2025. State-based marketplaces may have additional SEP options. When in doubt, contact the marketplace directly.