What Qualifies for a Special Enrollment Period

Change can be a scary thing, but it doesn’t have to be! Especially when it comes to health insurance. If you recently had a major life change— like getting married, having a baby, or losing health coverage— you are eligible for a Special Enrollment Period (SEP), allowing you to enroll in health insurance outside the yearly Open Enrollment Period. Doesn’t that sound reassuring?

With certain life changes you qualify for a SEP and have up to 60 days following the event to enroll in a health insurance plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply. So, it is important to plan ahead when possible so you are never without insurance. Wondering if you qualify for Special Enrollment Period? Below is a list of life events that make you eligible for SEP. Let’s take a look! 

Life changes that can qualify you for a Special Enrollment Period 

Changes in household1: 

  • Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
  • Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Death. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result, you’re no longer eligible for your current health plan.

Changes in residence1:

You may qualify for a Special Enrollment Period if you (or anyone in your household) have a change in your primary place of living and gain access to new Marketplace health plans as a result. Household moves that qualify you for a Special Enrollment Period include the below. 2

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or United States territory
  • If you’re a student, moving to or from the place you attend school
  • If you’re a seasonal worker, moving to or from the place you both live and work
  • Moving to or from a shelter or other transitional housing

Loss of health insurance:

You may qualify for a Special Enrollment Period if you (or anyone in your household) lost qualifying health coverage (or “minimum essential coverage”). Some examples of qualifying coverage include the below.2 

  • Losing job-based coverage
  • Losing individual health coverage for a plan or policy you bought yourself
  • Losing eligibility for Medicaid or CHIP
  • Losing eligibility for Medicare
  • Losing coverage through a family member

More qualifying changes:

  • Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

You may be asked to provide documentation of certain life events in order to qualify for SEP. If you have more questions on how to get health insurance during a Special Enrollment Period, give us a call or visit our website to learn more.


  1.   https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
  2.   https://marketplace.cms.gov/outreach-and-education/special-enrollment-periods-available-to-consumers.pdf
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