Special Enrollment Period: how to qualify for health coverage

You're eligible to buy health insurance after a major life event.

Elissa

Elissa Suh

Published August 7, 2019

KEY TAKEAWAYS

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

  • Eligibility requires a qualifying life event

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

Special Enrollment Period is a period outside of Open Enrollment when you 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. Special Enrollment Periods typically start on the day of the qualifying event and end 60 days after the qualifying event.

In this article:

How Special Enrollment works

If you don’t have insurance coverage and want to buy a health plan you can do so from the official health insurance marketplace (either a state or federal exchange).

If you need an individual health insurance policy, you typically sign up for during Open Enrollment, a 45-day period designated for shopping for health insurance. The next Open Enrollment window for marketplace coverage begins November 1, 2019, for a health insurance plan that begins January 1, 2020.

If you get coverage through a group health plan from your employer, you don’t have to wait for the enrollment period.

Outside of this initial enrollment period, you can’t buy an individual health plan unless you experience a qualifying life event (QLE), which is a major change in your life. (We’ll get into examples of specific events below.)

After you experience a qualifying life event, you’ll be granted a short time frame to buy health insurance. This time frame is called the Special Enrollment Period.

How long is the Special Enrollment Period?

You usually have 30 to 60 days to enroll in a health plan after a qualifying event. You can check with your state or federal exchange for the exact time frame.

What are the qualifying events for Special Enrollment Period?

The most common qualifying life events are a loss of coverage or change in your household or status. You can use the questionnaire on healthcare.gov to see if you’re eligible for the Special Enrollment Period. Here are some common examples:

  • Getting married or divorced
  • Having a baby
  • Becoming a citizen
  • Resigning from current employment
  • Your employer ending its group health plan without providing any replacement coverage
  • COBRA coverage ends
  • Lose Medicare or Medicaid eligibility or Children’s Health Insurance Program coverage
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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 a few alternatives to a traditional health plan you might consider. You could buy short-term health insurance, 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.

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

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