Special Enrollment Periods for complex issues

You can enroll in a private health plan through the Marketplace outside of Open Enrollment only if you qualify for a Special Enrollment Period.

• You have a

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. Refer to glossary for more details.

, like having a baby, getting married, moving, or losing minimum health coverage (like coverage through your job,

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Refer to glossary for more details.

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women. Refer to glossary for more details.

Unexpected situations

You faced a serious medical condition, natural disaster, or other national or state-level emergency that kept you from enrolling on time. For example:

• An unexpected hospitalization or temporary cognitive disability, or were otherwise incapacitated
• A natural disaster, such as an earthquake, massive flooding, or hurricane

To qualify due to a natural disaster, you must live (or have lived during the event) in a county that is eligible to apply for "individual assistance" or "public assistance" by the Federal Emergency Management Agency (FEMA).

• You have 60 days from the end of the FEMA-designated incident period to complete your enrollment in Marketplace coverage.
• You can also ask to have your plan start date be when you would have picked a plan if not for the disaster.
• Get FEMA designation information for your area.

Enrollment or plan information display errors

• Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, navigator, certified application counselor, or agent or broker) kept you from:
  • Enrolling in a plan, or the right plan for you
  • Getting the premium tax credit or cost-sharing reduction you qualified for
  • You from enrolling in a plan, or
  • Your health insurance company from getting your enrollment information

  Becoming newly eligible for savings on a Marketplace plan

  You previously lived in a state that hasn’t expanded Medicaid and weren’t eligible for

  Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels.

  Refer to glossary for more details.

  or a premium tax credit because your income was too low. But in the last 60 days, you had an increase in household income or moved, making you newly eligible for

  premium tax credits

  A tax credit you can use to lower your monthly insurance payment (called your “premium”) when you enroll in a plan through the Health Insurance Marketplace®. Your tax credit is based on the income estimate and household information you put on your Marketplace application.

  Refer to glossary for more details.

  Found not eligible for Medicaid or CHIP coverage

  You applied for Marketplace or Medicaid/CHIP coverage during Open Enrollment Open Enrollment Period
  November 1 - January 15 each year

  or with a different Special Enrollment period and were told you might be eligible for Medicaid/CHIP. But, when your state agency told you that you weren’t eligible, Open Enrollment or your Special Enrollment Period had already ended.

  You may qualify for a Special Enrollment Period whether you applied through the Marketplace or your state Medicaid and CHIP agency directly.

  Gaining or becoming a dependent due to a court order

  You gained a new dependent or became a dependent of someone else due to a child support or other court order. Coverage starts the same day as the effective date of the court order – even if you enroll in the plan up to 60 days afterward.

  Domestic abuse/violence or spousal abandonment

  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. 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. You may be 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.

  Successful appeal decision

  If you filed an appeal with the Marketplace and the decision is in your favor, you’ll have the option to enroll in or change plans. You'll get a letter with the Marketplace Appeals Center's final decision that will explain any changes, how we made the decision, and your next steps.

  If you think you qualify for a Special Enrollment Period

  Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

  We'll ask for information about your situation to check if you qualify for a Special Enrollment Period. If you qualify, we'll help you apply and enroll in coverage.

  If you’re already enrolled in a plan and you get a Special Enrollment Period, you can stay in your current plan (in most cases) or switch plans. In some limited cases, you may qualify for an earlier start date of coverage. Remember, you must make the first premium payment before your coverage starts.

  Filing an appeal

  If the Marketplace denies your request for a Special Enrollment Period, you can file an appeal. If your appeal is successful, you can get coverage back to the date your Special Enrollment Period was denied.