A Guide to Special Enrollment Periods

A Special Enrollment Period allows you to buy a health insurance plan any time you experience certain major life events.

Elissa

Updated October 9, 2020|3 min read

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KEY TAKEAWAYS

  • A Special Enrollment Period lets you buy coverage outside of the typical enrollment window

  • Eligibility for Special Enrollment requires a qualifying life event

  • The Special Enrollment Period typically ends 60 days after the life event

A Special Enrollment Period is a period outside of Open Enrollment when you can shop for and buy health insurance. You must have a qualifying life event in order to be eligible to buy a plan during this time. Common qualifying events include getting married, having a child, or losing your job. Special Enrollment Periods typically start on the day of the qualifying event and end 60 days after the qualifying event.

If you had health insurance through your employer and lost your job because of the coronavirus (COVID-19) pandemic, you qualify to get a new Obamacare plan through a Special Enrollment Period. Learn more about health insurance and the coronavirus.

How Special Enrollment works

There are two main times you can sign up for a new health insurance plan: Open Enrollment and a Special Enrollment.

Open Enrollment is a 45-day period when anyone can shop for health insurance (a group health plan from your employer may offer other windows, too). The next Open Enrollment window for marketplace coverage begins November 1, 2020 , for a health insurance plan that begins January 1, 2021 . The federal marketplace, healthcare.gov, let’s you compare and buy plans. If your state has its own marketplace, it may offer an extended enrollment period. Healthcare.gov will direct you to the proper website. You can also find your state’s exchange in our state-by-state guide to Open Enrollment.

Special Enrollment allows you to buy an individual health insurance plan after you experience a qualifying life event (QLE), which is a major change in your life. The next section gives more examples of specific events, but this could include changing jobs (whether you quit or get fired) or a change in your marital status. After your qualifying event, you’ll be granted a short time frame to buy health insurance. This time frame is called a Special Enrollment Period (sometimes abbreviated SEP).

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Medicare Special Enrollment

If you need to enroll in Medicare or make changes to your Medicare health plan, there are also open and special enrollment periods. However, Medicare enrollment periods differ from enrollment for regular health insurance: the timing of Open Enrollment is different and circumstances that qualify you for Special Enrollment aren’t the same. You can learn more in our guide to Medicare enrollment.

How long is the Special Enrollment Period?

You usually have 30 to 60 days to enroll in a health plan after a qualifying event. If you expect to lose health insurance coverage within the next 60 days, like if you know you will leave your job, you may even have access to a Special Enrollment Period before your qualifying event. You can check with your state or federal exchange for the exact time frame.

What are qualifying events for a Special Enrollment Period?

The most common qualifying life events are a loss of health insurance coverage or change in your marital status. You can use the Special Enrollment Period questionnaire on the federal marketplace to see if you’re eligible.

Here are some common examples of qualifying life events:

  • Getting married or divorced

  • Having a baby or adopting a child

  • Becoming a citizen

  • Leaving your current employer, whether you quit, resign, or are fired

  • Your employer ending its group health plan without providing any replacement coverage

  • COBRA coverage ending

  • Losing Medicare or Medicaid eligibility or Children’s Health Insurance Program (CHIP) coverage

  • Moving to a new zip code or county (vacations do not qualify)

  • Losing coverage through your parents, like after turning 26

  • Leaving incarceration

Alternatives to health insurance

If you need health coverage, but don’t foresee a life event that will trigger the Special Enrollment Period, there are some alternatives to a traditional health plans you might consider.

Short-term health insurance is a flexible plan that usually lasts only a few months. This type of plan may not provide extensive coverage, like a prescription drug plan or cover all health issues, so it is best as a temporary solution until Open Enrollment begins. Additionally, it does not qualify as minimum essential coverage, so you may have to pay a tax penalty for not having proper health insurance. (The Obamacare individual mandate was repealed starting in 2019 but some states levy a penalty for going without insurance.)

Technically not a health plan, a limited benefit plan will cover a part of your health care costs when you suffer from a medical event like a hospital visit. There might be restrictions to this health coverage if you have a pre-existing condition.

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Health insurance and life insurance work together to offer financial protection.

Health insurance can pay your medical expenses. Life insurance keeps your loved ones whole after you die.