Understanding Special Enrollment

If you experience a qualifying life event that affects your insurance needs, you can take advantage of a special enrollment period. This special enrollment period is created through an event from the list below occurring in your life. During this special enrollment period you are responsible for finding credible coverage and in some cases may have a limited time frame to do so.

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List of Qualifying Events

 

  • Loss of qualifying health coverage

    • Coverage from a job
    • Medicaid or Children’s Health Insurance Program
    • Medicare
    • Individual or group coverage that ends during the year.
    • If you turn 26 and are no longer eligible for your parents insurance plan.

 

  • Change in household size

    • Got married
    • Had a baby, adopted a child, or placed a child for foster care.
    • Got divorced, legally separated, or had a death in the family.
    • Gained or became a dependent due to a child support or other court order.

 

  • Change in primary place of residence

    • Moving to a new home in a new ZIP code or county
    • Moving to the U.S. from a foreign country
    • A student moving to or from the place he or she attends school
    • A seasonal worker relocated
    • Moving to or from a shelter or other transitional housing
    • NOTE: Starting July 2016 you must prove that you have had qualiifying coverage for one or more days in the last 60 days before you move to qualify.

 

  • Change in eligibility for Marketplace coverage or help paying for coverage

    • Are enrolled in Marketplace coverage and report a change that makes you:
      • Newly eligible for help paying for coverage.
      • Ineligible for help paying for coverage.
      • Eligible for a different amount of help paying for out-of-pocket costs, like copayments.
    • Become newly eligible for Marketplace coverage because you’ve become a U.S. Citizen.
    • Become newly eligible for Marketplace coverage because you’ve been released from incarceration.
    • Gain or maintain status of a federally recognized tribe (can change plans once per month).
    • Become newly eligible for help paying for Marketplace coverage because you had a change in household income or moved to a different state and you were previously both of these:
      • Ineligible for Medicaid coverage because you live in a state that hasn’t expanded Medicaid.
      • Ineligible for help paying for coverage because your household income was below 100% of the Federal Poverty Level.

 

  • Other qualifying changes

    • Applied for Medicaid or Children’s Health Insurance Program coverage during the Marketplace Open Enrollment Period, or after a qualifying life event, and your state Medicaid or CHIP agency determined you or they weren’t eligible.
    • Are a victim of domestic abuse or spousal abandonment and want to enroll in a health plan separate from your abuser or abandoner.
    • Are an AmeriCorps service member starting or ending AmeriCorps service.
    • Can show you had an exceptional circumstance that kept you from enrolling in coverage, like being incapacitated or a victim of a natural disaster.