Understanding Special Enrollment

A Special Enrollment period is a specified time outside of Open Enrollment when individuals and businesses can sign up for healthcare.

Under normal circumstances, individuals can get healthcare through their employer or on the Healthcare Exchange Marketplace during Open Enrollment. However, millions of people experience life and family changes throughout the year that require a change in health insurance. When this occurs, a Special Enrollment period is needed to ensure there is no lapse in coverage. Eligibility is considered and granted based on several factors known as qualifying life events.

Qualifying Life Events for Special Enrollment

To qualify for Special Enrollment, you must have a qualifying life event. A qualifying life event can include:

  • Change in or loss of a job
  • Marriage or divorce
  • Having or adopting a child
  • Moving
  • Death of a spouse
  • Drastically reduced income
  • Gaining United States citizenship
  • Release from jail
  • Loss of healthcare coverage

There are other, less common qualifying life events. Learn more about these and determine your eligibility.

Those who believe they qualify for Medicaid or the Children’s Health Insurance Plan (CHIP) — both federally and state funded health insurance programs — can enroll in those plans at any time of the year. There is no need to qualify for a Special Enrollment period for these programs; however, being denied to either of these options may qualify individuals for a Special Enrollment period.

With a qualifying life event, there is typically a 60-day window for the Special Enrollment during which individuals are responsible for obtaining healthcare. Once the 60-day window passes, they must wait until the following Open Enrollment to apply for and obtain health insurance unless there is an extenuating circumstance.

Extenuating Circumstances for Special Enrollment

There are some exceptions to Open Enrollment and consideration for a Special Enrollment period. A few of these exceptions include: 

  • A natural disaster (flooding, hurricane, earthquake, tornado, etc.)
  • Temporary cognitive disability
  • An unexpected and extended hospitalization
  • Information display error on the Marketplace Exchange website
  • Survivors of domestic violence or spousal abandonment

There are other circumstances in which individuals can obtain eligibility to enroll during a Special Enrollment period to sign up for health insurance. Extenuating circumstances can vary from person to person and can be handled on a case-by-case basis. For this reason, it is essential to have a healthcare insurance partner that you trust.