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Questions about your Eligibility based on my State or Situation

If you have Questions about your Eligibility based on a State or Situation

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Written by Amanda Roberts

This November 1 – December 15 window applies to individual health insurance shopping (marketplace open enrollment). If you're an employer asking when welcome emails or enrollment notices go out to your employees, that timing is based on your own plan's eligibility date, not this calendar window — see Scheduling Welcome Emails.

Open Enrollment runs November 1 through December 15, and during this window, anyone can shop for an individual health insurance plan, with coverage starting January 1. The December 15 deadline is firm and does not change based on the day of the week.

Outside of that window, you'll need a Qualifying Life Event (QLE) to enroll in or change an individual health insurance plan — unless your state runs an extended Open Enrollment period. You can check to see if your state' has an extended open enrollment here: Need health insurance? | HealthCare.gov Some states extend Open Enrollment through January 15 or January 31, with coverage starting February 1 for plans selected during these periods. States offering extended periods include Alaska, California, Colorado, Georgia, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Washington, Washington, D.C., and Virginia.

Qualified Life Events:

Loss of qualifying health coverage

  • Losing job-based coverage (including through a spouse or parent)

  • Aging off a parent's plan at 26

  • Losing Medicaid or CHIP eligibility

  • Losing individual/marketplace coverage for a reason other than not paying premiums

  • COBRA coverage ending

Household changes

  • Getting married

  • Divorce or legal separation (in states where it affects coverage eligibility)

  • Having a baby, adopting a child, or placing a child for foster care

  • Death of someone on the policy

Residence changes

  • Moving to a new ZIP code or county where different plans are available

  • A student moving to or from school

  • A seasonal worker moving to or from where they live and work

  • Moving to or from a shelter or transitional housing

ICHRA and QSEHRA specific

  • Becoming newly eligible for an ICHRA or QSEHRA — this is itself a QLE. Employees (and their dependents) get a 60-day SEP from their HRA eligibility date to enroll in or change an individual health plan.

  • A change in HRA affordability or offer terms that affects marketplace subsidy eligibility

Other qualifying changes

  • Gaining U.S. citizenship or lawful presence status

  • Release from incarceration

  • A change in income or household size that affects subsidy eligibility

  • A plan or issuer violation of its contract

  • An exceptional circumstance (natural disaster, serious medical condition, etc.) recognized by the exchange

If you do have a QLE you can shop for 60 days from the date of the event. For example, if an employee loses coverage on December 31, they qualify for a Special Enrollment Period starting that date, allowing them to enroll beyond the standard deadlines.

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