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 all change if Congress revises or repeals the Affordable Care Act, but for now the ACA remains in effect.

Open enrollment is the three-month 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 plan — unless your life changes in a big way.

Key terms
Open enrollment period: For individual health plans, this three-month period is the only time you can buy an individual health plan unless you have a “qualifying life event.” It takes place annually from Nov. 1 to Jan. 31.
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 individual 2017 health plans closed Jan. 31. For individual health plans in 2018, the open enrollment period will be from Nov. 1, 2017, to Jan. 31, 2018.

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

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. You typically have 60 days from the date of the qualifying life event to make the change.

You can visit a state or federal marketplace through Healthcare.gov to buy health insurance. If you’re making a change to your health plan, such as adding or removing a family member, contact your health insurance company directly.

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.

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, because 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.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.

Updated Feb. 8, 2017.