The annual Open Enrollment Period is over. You can now enroll in a 2016 insurance plan through the Health Insurance Marketplace only if you have a life event that qualifies you for a Special Enrollment Period.
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When you apply you’ll also find out if you qualify for coverage through Medicaid or the Children’s Health Insurance Program (CHIP). If you do, coverage can start the day you apply or earlier.
Changes that qualify for a Special Enrollment Period
Loss of health coverage
You may qualify for a Special Enrollment Period if you lost qualifying health coverage in the past 60 days OR expect anyone in your household to lose coverage in the next 60 days.
Coverage losses that may qualify you for a Special Enrollment Period:
Losing job-based coverage
You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:
- Your employer stops offering coverage
- You leave a job where you had health coverage (even if you left your job by choice or were fired).
- You have a reduction in work hours that causes you to lose your job-based plan.
- Your job-based plan doesn’t offer qualifying health coverage and as a result you become newly eligible for a premium tax credit. Qualifying health coverage through a job-based plan means that the coverage is affordable and meets minimum value standards. If you want to find out if your employer’s coverage meets the standards, ask your employer to complete the Employer Coverage tool (PDF) to see if your job-based plan meets these requirements. Most job-based plans do.
- Your job-based health plan is ending for the year and you choose not to renew it. Note: If this plan is affordable and meets minimum value standards, you won’t qualify for a premium tax credit that lowers the cost of your plan, even though you can buy Marketplace insurance.
- Your COBRA coverage runs out (but not if you end your COBRA coverage early). Note: If you enroll in COBRA and end it early during a Marketplace Open Enrollment Period, you can enroll in Marketplace coverage at that time.
Important: Losing coverage from your employer doesn’t qualify for a Special Enrollment Period if you voluntarily drop the coverage while still working for the employer, if you lost the coverage because you didn’t pay your premium, or if you enrolled in COBRA coverage and chose to end it early outside Open Enrollment.
Losing individual health coverage for a plan or policy you bought yourself
You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:
- Your individual plan or your Marketplace plan is discontinued (no longer exists).
- You lose eligibility for a student health plan.
- You lose eligibility for a plan because you no longer live in the plan’s service area.
- Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.
Important: Losing individual coverage doesn’t allow you to qualify for a Special Enrollment Period if you voluntarily drop coverage, if you lose coverage because you didn’t pay your premiums, or if you lose Marketplace coverage because you didn’t provide sufficient documentation for the Marketplace to resolve a data-matching issue.
Losing eligibility for Medicaid or CHIP
You may qualify for a Special Enrollment Period if you lose Medicaid or the Children’s Health Insurance Program (CHIP) because:
- You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.
- Your child ages off CHIP.
Losing eligibility for Medicare
You may qualify for a Special Enrollment Period if you become no longer eligible for premium-free Medicare Part A.
You don’t qualify for a Special Enrollment Period if:
- You lose Medicare Part A because of you didn’t pay your Medicare premium
- You lose Medicare Parts B, C, or D only.
Losing coverage through a family member
You may qualify for a Special Enrollment Period if you lose qualifying health coverage that you had through a parent, spouse, or other family member. This might happen if:
- You turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent’s health plan.
- You lose job-based health coverage through a family member’s employer because that family member loses health coverage or loses coverage for dependents.
- You lose health coverage through a spouse due to a divorce or legal separation.
- You lose health coverage due to the death of a family member.
- You lose health coverage through a parent or guardian because you’re no longer a dependent.
Remember: Losing coverage you have as a dependent doesn’t allow you to qualify for a Special Enrollment Period if you voluntary drop the coverage.
Changes in household size
You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:
- 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 residence
Household moves that qualify you for a Special Enrollment Period:
- Moving to a new home
- A student moving to or from the place they attend school
- A seasonal worker moving to or from the place they both live and work
- Moving to or from a shelter or other transitional housing
Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for an SEP.
More qualifying changes
Other life changes that may qualify you for a Special Enrollment Period:
- Changes in your income that affect the coverage you qualify for
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming a U.S. citizen
- Leaving incarceration (jail or prison)
- AmeriCorps members starting or ending their service
Learn more about Special Enrollment Periods for complex issues.
IMPORTANT: When you apply, you must attest that the information you provide on the application is true, including the facts that qualify you for a Special Enrollment Period. You may be asked to provide documents that prove your eligibility to enroll.
More answers: Getting 2016 coverage with a Special Enrollment Period
The Open Enrollment Period for 2017 coverage will begin in the fall. In the meantime, you can sign up for Marketplace emails to get timely reminders to help you enroll next year.