Before You Continue
This article applies to employees seeking individual health insurance coverage after Open Enrollment has ended and who want to understand whether they can still obtain coverage. If you recently experienced a qualifying life event such as losing coverage, getting married, having a child, or moving, you may qualify for a Special Enrollment Period and can skip to What should I do if I think I qualify for a Special Enrollment Period?
If you miss Open Enrollment, you generally cannot enroll in or change an ACA-compliant individual health insurance plan until the next Open Enrollment period unless you qualify for a Special Enrollment Period (SEP). Open Enrollment typically occurs once each year, and enrollment outside that window is generally limited to individuals who experience a qualifying life event.
Can I still get health insurance after Open Enrollment ends?
Yes, but only if you qualify for a Special Enrollment Period
Outside of Open Enrollment, enrollment in ACA-compliant individual health insurance is generally limited to people who experience certain qualifying events.
Most Special Enrollment Periods allow you to enroll within a limited timeframe after the qualifying event occurs, so it is important to act promptly.
What events qualify for a Special Enrollment Period?
Common qualifying life events
You may qualify for a Special Enrollment Period if you experience one of the following:
Loss of employer-sponsored health coverage
Loss of Medicaid or CHIP eligibility
Turning age 26 and aging off a parent's plan
Marriage
Divorce that results in loss of coverage
Birth of a child
Adoption or foster placement
Death of a covered family member
Moving to a new service area, ZIP code, or county
Gaining lawful immigration status or citizenship
Becoming eligible for certain employer-sponsored HRA benefits, including an ICHRA or QSEHRA offer in qualifying situations
Important
You may be required to provide documentation supporting your qualifying event before coverage can begin.
What if I do not have a qualifying life event?
You may need to wait until the next Open Enrollment period
If you do not qualify for a Special Enrollment Period:
You generally cannot enroll in a new ACA-compliant individual health insurance plan
You may need to wait until the next Open Enrollment period
You may experience a gap in coverage until new enrollment becomes available
Not applicable
Missing Open Enrollment by itself is not considered a qualifying life event and does not create a Special Enrollment Period.
Stop Here If You Do Not Qualify for an SEP
If you have not experienced a qualifying life event, you generally cannot enroll in an ACA-compliant individual health insurance plan until the next Open Enrollment period.
Stop Here
If you do not participate in an ICHRA or QSEHRA, you can skip this section and continue to Are there any other coverage options?
How does missing Open Enrollment affect my HRA?
HRA participation may be impacted if you do not have qualifying coverage
For ICHRA participants
Employees must maintain qualifying individual health insurance or eligible Medicare coverage to receive tax-free reimbursements.
Without qualifying coverage:
You cannot participate in the ICHRA reimbursement benefit
Reimbursements cannot be approved until qualifying coverage is obtained
For QSEHRA participants
Premium reimbursements generally require qualifying health coverage.
If you do not maintain eligible coverage:
Premium reimbursements are not available
Medical expense reimbursement eligibility may be affected based on applicable rules and plan design
Are there any other coverage options?
Alternative coverage options may be available
Depending on your circumstances, you may have access to:
Medicaid
Children's Health Insurance Program (CHIP)
COBRA continuation coverage
Employer-sponsored coverage through a spouse
Other non-Marketplace coverage options
Availability and eligibility requirements vary based on your circumstance and location.
Important
Not all alternative coverage options qualify for reimbursement under an ICHRA or QSEHRA.
What should I do if I think I qualify for a Special Enrollment Period?
Take action as soon as possible
Identify the qualifying event.
Gather supporting documentation.
Complete your enrollment application promptly.
Submit any requested verification documents.
Confirm your enrollment effective date.
Many Special Enrollment Periods are time-limited and may expire if action is not taken within the required window.