Get or Change Coverage Outside of Open Enrollment

If you missed Open Enrollment (November 1-January 15), you might still be able to get health coverage if you qualify for a Special Enrollment Period or apply for Medicaid or the Children's Health Insurance Program (CHIP).

Check if You Qualify

• Qualify for a Special Enrollment Period: You may qualify for a Special Enrollment Period due to a life event, like losing other coverage, getting married, having a baby, or based on estimated household income. To get coverage, you’ll need to apply. Create a Marketplace account (or log into your existing one) to start your application. Before you apply, you can preview plans and prices. If you already have Marketplace coverage, learn how to report a change. Once you update your application, your Eligibility Results will tell you if you qualify for a Special Enrollment Period to switch plans. Learn more about Special Enrollment Periods.

• Apply for Medicaid or CHIP: You can apply for free or low-cost coverage through Medicaid and CHIP at any time during the year. If you qualify, you can enroll immediately.

Special Enrollment Periods

Outside of Open Enrollment, you can only enroll in or change Marketplace plans if you qualify for a Special Enrollment Period due to certain life changes or your estimated household income. Here's what you need to know:

Life Changes

Special Enrollment Period details vary depending on the life change:

• Changes in Household:

  • Marriage: If you got married in the past 60 days, you may qualify for a Special Enrollment Period. Enroll by the last day of the month, and your coverage can start on the first day of the next month.
  • Birth, Adoption, or Foster Care Placement: If you had a baby, adopted a child, or placed a child in foster care, your coverage can start on the day of the event — even if you enroll in a plan up to 60 days afterward.
  • Divorce or Legal Separation: If you got divorced or legally separated and lost health insurance, you might qualify for a Special Enrollment Period. However, divorce or legal separation without losing coverage does not qualify.
  • Death: If someone on your Marketplace plan dies and it causes you to lose your current health plan, you may qualify for a Special Enrollment Period.

• Changes in Residence:

  • You may qualify if you move to:
    • A new home in a different ZIP code or county
    • The U.S. from a foreign country or U.S. territory
  • Or, if you move to or from:
    • A place where you attend school (if you're a student)
    • A place where you live and work (if you're a seasonal worker)
    • A shelter or other transitional housing
  • Important: Moving solely for medical treatment or staying somewhere for vacation does not qualify. You must prove you had qualifying health coverage for at least one day during the 60 days before your move. This proof is not required if you’re moving from a foreign country or U.S. territory.

• Loss of Health Coverage:

  • You may qualify if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days.

Check if you qualify and take the necessary steps to secure your health coverage during a Special Enrollment Period.

Changing Plans — What You Need to Know

You can change your health plan during Open Enrollment, but outside of this period, you’ll need to qualify for a Special Enrollment Period due to a life event. Here’s what you need to know about changing plans:

• Limited Plan Categories:
  • During a Special Enrollment Period, you may have a limited selection of health plan categories.
  • You’ll likely need to choose a new plan within the same category as your current plan.
  • In certain situations, you may be allowed to change plan categories.

Learn more about health plan categories.

Special Enrollment Periods with Limited Plan Choices

If you qualify for one of the most common Special Enrollment Periods, such as losing health insurance, moving to a new home, or a change in household size, you and your dependents will generally be limited to selecting a plan from your current category. For example, if you’re enrolled in a Bronze plan, you can only switch to another Bronze plan.

Situations That Allow You to Change Plan Categories

In certain cases, you may be able to change to a different plan category during a Special Enrollment Period:

• Becoming Eligible for Extra Savings:

  • If you qualify for extra savings ("cost-sharing reductions") and aren’t enrolled in a Silver plan, you can switch to a Silver plan to take advantage of these savings.
  • Silver plans are also available if you qualify for the premium tax credit and enroll through a Special Enrollment Period based on estimated household income.

• Losing Extra Savings:

  • If you lose your eligibility for extra savings and are enrolled in a Silver plan, you’ll qualify for a Special Enrollment Period. You can switch to a Bronze, Silver, or Gold plan that better suits your needs and budget.

• Adding New Household Members:

  • If your household size increases due to marriage, birth, adoption, foster care, or a court order, you can add the new dependent to your current plan or enroll them in any plan for the rest of the year.
  • Note: This option only applies to the new household member. Existing enrollees can’t change plans.

• Plan Rules Restricting New Members:

  • If your current plan doesn’t allow adding new members, your family can enroll together in a different plan within the same category. If no plans are available in your category, you can choose one that’s one level up or down.

• Employer Offer for Coverage Cost Assistance:

  • If your employer offers an individual coverage HRA or a QSEHRA to help with coverage costs, you can choose a new plan during a Special Enrollment Period. Ensure your new plan starts by the date your HRA or QSEHRA begins, unless a later date is offered.

Learn more about HRAs and QSEHRAs.

Other Special Enrollment Periods

Some Special Enrollment Periods, like those due to misrepresentation, plan display errors, or unique situations like being a member of a federally recognized tribe, don’t limit your ability to choose a new plan.

Sending Documents to Confirm a Special Enrollment Period

When you apply for Marketplace coverage and qualify for a Special Enrollment Period (SEP) due to a life event, you may need to submit documents to verify your eligibility. These documents must be provided before your coverage becomes active.

• When to Submit Documents: After submitting your application, you’ll be informed if documents are required through your Marketplace Eligibility Notice. It's best to choose a plan first and then submit your documents. Once you’ve selected a plan, you have 30 days to send in the necessary documents.

• Coverage Start Date: Your coverage start date is determined by when you choose a plan, but you won’t be able to use your coverage until your eligibility is confirmed and your first premium is paid.

• No Document Submission Required: If your eligibility notice doesn’t request additional documents, you can simply pick a plan and enroll without any further steps.

• Ready to Upload Documents? Follow these steps to submit your documents promptly.

If You Lost or Will Lose Health Coverage

You’ll need to provide documents that show proof of your lost coverage and the date it ends, whether you’ve already lost coverage or will lose it in the future.

How to Submit Documents

To avoid delays in starting your coverage, submit the required documents as soon as possible after picking a plan. You can find a full list of acceptable documents to confirm your loss of coverage.

• Upload: Uploading is the fastest way to submit your documents. You’ll need scanned copies or clear photos of your documents in one of these accepted formats: .pdf, .jpeg, .jpg, .gif, .xml, .png, .tiff, .bmp. The maximum file size is 10MB, and file names shouldn’t include special characters like / \ : * ? “ |. Once ready, log into HealthCare.gov and follow the step-by-step instructions to upload your documents.

After Submitting Your Documents

You should receive a letter in your HealthCare.gov account within a couple of weeks confirming whether your Special Enrollment Period has been verified.

• If Your SEP Is Confirmed: We’ll notify the insurance plan you chose, and you’ll need to pay your first premium directly to the insurance company. Your coverage won’t start until this payment is made.

• Retroactive Coverage: If confirmation delays prevent you from using your plan after the coverage start date, you may need to pay premiums for previous months. If so, medical expenses incurred after your start date may be covered.

• If Your SEP Can’t Be Confirmed: You’ll receive a letter explaining why your SEP wasn’t confirmed. You can then upload different documents to try to confirm your eligibility.