Get or Change Coverage Outside of Open Enrollment

If you missed the Open Enrollment period (November 1 - January 15), you might still be able to obtain health coverage through a Special Enrollment Period, or by applying for Medicaid or the Children's Health Insurance Program (CHIP).

Check Your Eligibility

Qualify for a Special Enrollment Period

You may be eligible for a Special Enrollment Period if you experience a qualifying life event, such as:

• Losing other health coverage
• Getting married
• Having a baby
• Changes in your estimated household income

To apply for coverage, create a Marketplace account or log into your existing account to start your application. Before applying, you can preview available plans and prices.

If you already have Marketplace coverage and need to report a change, update your application to see if you qualify for a Special Enrollment Period to switch plans.

Learn More: Explore details about Special Enrollment Periods.

Apply for Medicaid or CHIP

You can apply for Medicaid or the Children's Health Insurance Program (CHIP) at any time throughout the year. If you qualify, you can enroll immediately for free or low-cost coverage.

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 specific life changes or changes in your estimated household income. Check your eligibility.

Life Changes

Changes in Household

You may qualify for a Special Enrollment Period if, within the past 60 days, you or anyone in your household:

• Got Married: Choose a plan by the end of the month, and coverage can start on the first day of the following month.
• Had a Baby, Adopted a Child, or Placed a Child for Foster Care: Coverage can begin on the day of the event, even if you enroll up to 60 days later.
• Got Divorced or Legally Separated and Lost Health Insurance: Divorce or legal separation alone doesn’t qualify unless it causes a loss of coverage.
• Died: If someone covered under your Marketplace plan dies, leading to the loss of your current health plan, you qualify for a Special Enrollment Period.

Changes in Residence

You may qualify for a Special Enrollment Period 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
• A place where you attend school (if you’re a student)
• A place where you both live and work (if you’re a seasonal worker)
• Shelter or other transitional housing

Moving solely for medical treatment or vacation does not qualify you.

You must provide proof of having qualifying health coverage for at least one day during the 60 days before your move. No proof is required if moving from a foreign country or U.S. territory.

Loss of Health Coverage

You may qualify for a Special Enrollment Period 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.

Changing Plans — What You Need to Know

You can change health plans during Open Enrollment. Outside of Open Enrollment, you can only change plans if you qualify for a Special Enrollment Period (SEP) due to a life event or other qualifying circumstances. Here’s what you need to know:

Changing Plans During a Special Enrollment Period

• Plan Categories: When changing plans during a Special Enrollment Period, you may have limited options compared to Open Enrollment. You might be restricted to choosing from the same plan category as your current plan.
• Limited Options: For most common SEPs (e.g., loss of health coverage, moving to a new home, changes in household size), you will typically only be able to select a new plan within your current plan category.

Situations Allowing Plan Category Changes

You may be able to switch to a different plan category during a Special Enrollment Period in specific circumstances:

• Eligibility for Extra Savings: If you become eligible for additional savings (cost-sharing reductions) and are not currently enrolled in a Silver plan, you can choose a Silver plan to take advantage of these savings. Silver plans might also be available if you qualify for premium tax credits based on estimated household income.
• Loss of Extra Savings: If you lose eligibility for extra savings and are currently enrolled in a Silver plan, you qualify for a Special Enrollment Period. You can then select a plan from the Bronze, Silver, or Gold categories that fits your needs and budget.
• New Household Members: If your household size increases due to marriage, birth, adoption, foster care, or court order, you can either add the new member to your current plan or enroll them in a separate plan. This applies only to the new household member; existing enrollees cannot change plans.

What If You Can’t Add New Household Members?

If your current plan doesn’t allow adding new members, your family can:

• Enroll Together: Choose a different plan within the same category. If no options are available in your current category, you can select a plan one level up or down.

Employer Coverage Assistance

If you receive an individual coverage Health Reimbursement Arrangement (HRA) or a Qualified Small Employer HRA (QSEHRA) from your employer:

• Plan Enrollment: You can still select a new plan during a Special Enrollment Period. Ensure that the new plan starts when your HRA or QSEHRA begins, unless your employer offers a later start date.

Other Special Enrollment Periods

Certain SEPs, such as those related to misrepresentation, plan display errors, or membership in federally recognized tribes or ANCSA Corporation shareholders, do not restrict your ability to choose a new plan during the SEP. Learn more about these unique Special Enrollment Periods.

Sending Documents to Confirm a Special Enrollment Period

When applying for Marketplace coverage and qualifying for a Special Enrollment Period (SEP) due to a life event, you may be required to submit documentation to verify your eligibility. You must provide these documents before you can begin using your coverage.

What You Need to Do

1.Wait for Notification:

• After submitting your application, you’ll receive a Marketplace Eligibility Notice that will indicate if you need to provide additional documents.
• It’s advisable to select your plan first and then submit the required documents. You have 30 days from selecting your plan to send in your documents.

2. Coverage Start Date:

• Your coverage start date is determined by when you choose a plan. However, you cannot use your coverage until your eligibility is confirmed and your first premium payment is made.

3. No Document Request:

• If your Eligibility Notice does not specify the need for additional documents, you can proceed by simply picking a plan and enrolling.

Ready to Upload Your Documents?

If you need to provide proof of lost or impending loss of health coverage, follow these instructions:

1.Documents Required:

• For lost coverage: Provide documentation showing the coverage was lost and the end date.
• For future loss of coverage: Submit documents indicating when your coverage will end.

2. How to Submit Documents:

Upload:

• This is the quickest method. Prepare scanned copies or clear photos of the documents.
• Document Requirements:
  • Accepted Formats: .pdf, .jpeg, .jpg, .gif, .xml, .png, .tiff, .bmp
  • Maximum File Size: 10MB
  • File Names: Avoid special characters like / \ : * ? “ |

Uploading your documents promptly helps prevent delays in the start of your coverage.

For a complete list of acceptable documents or further details, refer to the instructions provided in your Marketplace Eligibility Notice.