Qualifying Life Events and Special Enrollment Periods for ACA Health Insurance

Finding Health Insurance, Health
Your Guide to Understanding Qualifying Life Events and Special Enrollment Periods

Federal law requires most Americans to have health insurance or pay a tax penalty. That could change if Congress revises or repeals the Affordable Care Act, but for now the ACA remains in effect.

Open enrollment is the 45-day period when you can sign up for coverage under the ACA or change your existing plan. Outside of open enrollment, you can’t sign up for an individual health insurance plan — unless your life changes in a big way.

Open enrollment for individual health plans is from Nov. 1 to Dec. 15 each year.
Key terms
Open enrollment period: This 45-day period is the only time you can buy an individual health plan unless you have a “qualifying life event.”
Qualifying life event: A major event that affects your health insurance needs and qualifies you to make changes to or buy a health plan outside of open enrollment.
Special enrollment period: The time period after a qualifying life event, typically 60 days, when you can change your health plan or enroll in a new plan.

Special enrollment periods

Open enrollment for 2018 individual health plans will be from Nov. 1 to Dec. 15, 2017.

If you get health insurance through an employer, a university as a student, Medicare or Medicaid, your enrollment period will be different.

If you experience a qualifying life event, you can take advantage of a special enrollment period to make changes to your individual health plan or buy a new one. In most cases, you’ll have 60 days from the date of the qualifying life event to make the change.

You can use a health insurance agent or visit a state or federal marketplace through Healthcare.gov to buy health insurance.

Qualifying life events for individual health insurance

Life event Examples
Loss of health insurance
Changes in household
  • Marriage or divorce
  • Having a baby or adopting a child
  • Losing coverage due to a family member’s death
Changes in residence
  • Moving to a different ZIP code or county
  • A student moving to or from school
  • A seasonal worker moving to or from a work location
  • Moving to or from a shelter or transitional housing
Other qualifying events
  • Becoming eligible for Medicaid
  • Becoming eligible for tax credits that will lower your premiums, if you already have an ACA plan
  • Gaining membership in a federally recognized tribe
  • Becoming a U.S. citizen
  • Leaving jail or prison

Other situations may qualify you for a special enrollment period and are considered on a case-by-case basis. See a list of these complex issues at Healthcare.gov.

Proving a qualifying life event: New Healthcare.gov plan customers may be asked to provide documentation of certain life events in order to qualify for special enrollment. Life events that may require proof include:

  • Loss of existing health insurance
  • Change in household size
  • Moving to a new location
  • Any of the rare issues handled on a case-by-case basis

When you apply for health insurance through a state or federal marketplace, you’ll be notified which type of documentation to provide, if any. You can then upload documents directly to the marketplace — you’ll have 30 days to do so. Once it’s verified and you’ve paid your first premium, you can typically begin using coverage.

Missed open enrollment and don’t have a qualifying life event?

If you missed open enrollment and don’t qualify for special enrollment, you may be able to get health insurance through a public program if your household income is low:

  • Medicaid, for low-income adults, enrolls year-round
  • CHIP, for low-income children, also enrolls year-round

Medicaid and CHIP eligibility requirements vary by state. You can check your state’s guidelines at Medicaid.gov to see whether you qualify.

Another option is to sign up for a temporary health insurance plan. These plans typically are available directly from an insurer, but read policy details carefully before you buy. They may not cover common services like mental health care or prescription drugs. Also, short-term or temporary health plans don’t count as “minimum coverage” under federal law, and you may still face a tax penalty for not having health insurance.

» MORE: The penalty for not having health insurance

Updated Aug. 30, 2017.