Trying to enroll in a major medical plan after Open Enrollment (Nov 1-Dec 15 each year) requires a qualifying life event to trigger a Special Enrollment Period. There are several life changes that can qualify you for a Special Enrollment Period and they revolve around: changes in household size, changes in residences, loss of coverage, and becoming eligible for QSEHRA or ICHRA reimbursements.
Changes in household
You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:
Got married
Had a baby, adopted a child, or placed a child for foster care
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 in a new ZIP code or county
Moving to the U.S. from a foreign country or United States territory
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.
Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.
Loss of health insurance
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.
Coverage losses that may qualify you for a Special Enrollment Period:
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
Other life circumstances that may qualify you for a Special Enrollment Period:
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
AmeriCorps VISTA members starting or ending their service
Becoming newly eligible for a QSEHRA or ICHRA