Special Enrollment Periods: the life events that let you buy coverage now

Most people believe that missing Open Enrollment means waiting a year. Often it does not. A qualifying life event opens a Special Enrollment Period, and the window is usually 60 days from the event — which is why acting quickly matters more than understanding every detail.

Losing other coverage

This is the most common qualifying event, and it covers more situations than people expect. What matters is that you lost minimum essential coverage involuntarily — not that you chose to drop it.

• Losing job-based coverage, whether you left, were laid off, or had your hours reduced
• Losing coverage as a dependent through divorce, legal separation or the death of the policyholder
• Turning 26 and ageing off a parent's plan
• Losing Medicaid or CHIP eligibility
• A COBRA continuation period ending — the period ending, not you choosing to stop paying for it
• An individual plan being discontinued and not renewed

Household changes

• Getting married — coverage generally starts the first of the month after you enroll
• Having a baby, adopting, or placing a child in foster care — coverage can be backdated to the date of the event
• Divorce or legal separation, where it causes a loss of coverage
• A death in the household that changes your eligibility or your household size

Moving

A permanent move that changes the plans available to you qualifies — moving to a different ZIP code or county, moving to the United States from abroad, a student moving to or from school, or a seasonal worker moving to or from a place they live and work.

There is a condition worth knowing: in most cases you must have had qualifying coverage for at least one day in the 60 days before the move. A move alone, from a position of being uninsured, does not usually open the window.

Income-based and other events

• A change in income that changes your eligibility for savings or for Medicaid
• Becoming a US citizen or gaining lawful presence
• Leaving incarceration
• Gaining membership in a federally recognized tribe — which carries its own monthly enrollment rules
• A plan or Marketplace error that affected your enrollment
• Certain very low income levels, which may qualify for a monthly enrollment opportunity
• This is not a complete list of Special Enrollment Periods. Visit HealthCare.gov for the full list.

The 60-day rule, in both directions

For most events the window is 60 days from the date it happened. For a loss of coverage you can usually act in the 60 days before the loss as well as the 60 days after — and applying before is much better, because it can prevent a gap rather than patch one.

Miss the window and, in most cases, you are waiting for the next Open Enrollment. That is the entire reason this article is short: the details matter less than moving now.

What you will be asked to prove

The Marketplace usually asks for documentation. Have these ready and the process is straightforward:

• Loss of coverage: a letter from the employer or insurer stating the coverage type and the exact end date
• Marriage: a marriage certificate
• Birth or adoption: a birth certificate or the adoption or placement record
• Moving: a lease, mortgage statement, or official mail at both the old and new addresses

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The bottom line

If something changed in the last two months, do not assume you have to wait. Call and ask — the check takes a few minutes, and applying before a loss of coverage is far better than applying after.