When the Open Enrollment Period for the year is over, you can only enroll in or change a health plan if you qualify for a Special Enrollment Period.
Qualifying Special Enrollment Events
There are many events that trigger a special enrollment opportunity, such as:
- Loss of minimum essential coverage or other qualifying coverage (i.e., loss of employee-based coverage, Medicaid or CHIP, or coverage after a divorce)
- Marriage (if one or both spouses had other qualifying coverage or minimum essential coverage for at least one day during the 60 days prior to the marriage)
- Gaining a dependent (through foster care, adoption, or court order)
- Aging off a parent’s plan at 26 years or other loss of Dependent status
- Moving to another state
- Change in immigration status from a non-eligible status to an eligible one
- Leaving incarceration
Populations That Qualify Throughout The Year
Some populations are also able to enroll throughout the year without experiencing events, such as:
- Consumers who are American Indian or Alaska Natives can enroll or change their marketplace plan one time per month. More information can be found at https://www.healthcare.gov/american-indians-alaska-natives/
- If you’re a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner, contact a Navigator. Your dependents may be eligible too. If you’re married to your abuser/abandoner, you can answer on your Marketplace application that you’re unmarried, without fear of penalty for misstating your marital status. You then become eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income. If you qualify for this SEP, you’ll have 60 days to enroll in a Marketplace plan.
Documents For Enrollment Applications
If you qualify for a Special Enrollment Period and apply for Marketplace coverage, you may be asked to provide documents to confirm the events that make you eligible.
- You’ll learn if you must provide documents after you submit your application. Details and instructions will appear on your eligibility notice.
- It’s best to pick a plan first and submit your documents afterwards. After you pick a plan, you have 30 days to send the documents.
- You must send the documents before you can start using your coverage.
- Your coverage start date is based on when you pick a plan.
- You can’t use your coverage until your eligibility is confirmed and you make your first premium payment.
- If your eligibility notice doesn’t say you need to submit documents, you don’t have to. Simply pick a plan and enroll.
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