Special Enrollment Periods: Qualifying Life Events and Deadlines
If you miss open enrollment, you are not always out of luck. A Special Enrollment Period (SEP) lets you buy or change Marketplace coverage after certain life events. Employer plans have their own version. But SEPs have short deadlines, and they often require proof, so it helps to know the rules before you need them.
What is a qualifying life event
Coverage-related life events generally fall into a few groups. For the federal Marketplace, you usually have 60 days from the event to pick a plan. For the common categories:
- Loss of other qualifying coverage: losing job-based coverage, aging off a parent’s plan at 26, losing Medicaid or CHIP, or losing coverage when a divorce or the death of the policyholder ends your eligibility. It does not include losing coverage because you did not pay the premium, or because you voluntarily dropped it.
- Changes in household: getting married, having or adopting a baby or placing a child for foster care, getting divorced (only if you lose coverage), or the death of a family member who was on your plan.
- Changes in residence: moving to a new ZIP code or county where different plans are available. In most cases, you must have had qualifying coverage for at least one of the 60 days before the move, with some exceptions such as moving from outside the country or leaving a college dorm.
- Other situations: gaining citizenship or lawful presence, release from incarceration, a change in eligibility for subsidies, or being in a situation where the Marketplace made an error or the insurer violated its contract.
Medicaid and CHIP enrollment is open year-round; you can apply at any time.
An income-based SEP
From 2022 through 2025, the federal Marketplace had an SEP for households with income at or below 150% of poverty. A 2025 federal rule paused this SEP, and it has also been the subject of court challenges. Check HealthCare.gov for its current status before relying on it, and see if your state exchange offers a similar option, because states can set their own rules.
When does coverage start
| Event | Coverage generally starts |
|---|---|
| Loss of coverage (selected before or within the 60 days) | The first of the month after the loss, if you pick a plan before the loss; the first of the month after you pick, if you pick later |
| Marriage | First of the month after you choose a plan |
| Birth, adoption or foster placement | Can be backdated to the date of the event |
| Permanent move | First of the month after you choose a plan |
Details differ by state exchange, so read your confirmation. If you are leaving employer coverage, ask your HR department for the exact last day of coverage, as it determines the start of your plan so you avoid a gap. A gap of even one day can leave you exposed to a large bill.
COBRA, Marketplace or spouse’s plan
When you lose job-based coverage, you may be offered COBRA, which lets you continue the same plan, but you pay the full premium plus up to a 2% administrative fee. Compare COBRA with a Marketplace plan, because the Marketplace may be cheaper with a subsidy. Choosing COBRA does not take away your right to use the 60-day SEP for the loss of coverage. However, if you decide later to drop COBRA outside of open enrollment, that is not by itself a qualifying event, unless COBRA ends because the employer stops offering coverage or the maximum period is over. If your spouse has job-based coverage, you may have a separate HIPAA special enrollment right, normally 30 days after losing other coverage or a life event (and 60 days for Medicaid or CHIP changes).
What to keep as proof
The Marketplace may ask you to upload documents within 30 days. Typical examples are a letter from a former employer or insurer that shows the date coverage ended, a marriage certificate, a birth certificate or a lease or utility bill showing the date of a move. Take screenshots of what you submit. If you do not respond in time, your plan can be cancelled.
Plan metal level restrictions
In many SEPs, if you already have coverage and a qualifying event allows a change, you may be limited to a plan at the same metal tier, and the rules vary. People who add a family member can usually add them to the existing plan or change plans for everyone. Check what the Marketplace allows for your event.
Subsidies during an SEP
The premium tax credit is available after the SEP in the same way as in open enrollment. If your income changes because of the event (for example, a job loss), update your estimate for the whole year, not only for the months left. The subsidy calculator can help you estimate the credit. Note that a person who gets unemployment compensation has that income counted in MAGI.
If you do not qualify
If you have no qualifying event, you may have to wait for the next open enrollment. Short-term and other limited plans exist but are not comprehensive coverage and often exclude pre-existing conditions. For employer plans, ask HR about the deadline for changing elections after a life event; it is often only 30 days. For more on the yearly window, see the open enrollment checklist.
A short example
Priya’s job ends on November 18, and her employer coverage ends on November 30. Because she knows the date, she can pick a plan on HealthCare.gov any time within 60 days before it, and her new coverage can begin on December 1 with no gap if she chooses a plan by November 30. If she waits until January 10, she is still within 60 days after the loss, but her coverage will start on February 1, leaving her uninsured for two months. She also compares COBRA, which would cost $720 a month, with a subsidized plan that costs $210 a month. The difference is largely due to the subsidy. This example shows why the exact date matters, and why you should act before the old plan ends rather than after.