HEALTH INSURANCE MARKETPLACE
Special Enrollment Periods for the Health Insurance Marketplace A Special Enrollment Period may allow you to enroll in a Marketplace plan outside of the annual Open Enrollment Period if you experience a qualifying event. You may qualify for a Special Enrollment Period in these situations:
1. Loss of qualifying health coverage -You may qualify for a Special Enrollment Period if you (or anyone in your household) lost qualifying health coverage. Some examples of qualifying coverage include:
• Coverage through a job, or through another person’s job. » This also applies if you’re now eligible for help paying for coverage because your employer stops offering coverage or the coverage isn’t considered qualifying coverage.
• Medicaid or Children’s Health Insurance Program (CHIP) coverage (including pregnancy-related coverage and medically needy coverage).
• Medicare. • Individual or group health plan coverage that ends during the year.
• Coverage under your parent’s health plan (if you’re on it). If you turn 26 or the maximum dependent age allowed in your state and lose coverage, you can qualify for this Special Enrollment Period. Note: This Special Enrollment Period doesn’t include loss of coverage because you didn’t pay your premiums.
2. Change in household size You may qualify for a Special Enrollment Period if you (or anyone in your household):
• 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 and lost health coverage.
• Gained or became a dependent due to a child support or other court order.
3. Change in primary place of living You may qualify for a Special Enrollment Period if you (or anyone in your household) have a change in your primary place of living and gain access to new qualified health plans as a result. This includes:
• Moving to a new home in a new ZIP code or county.
• Moving to the U.S. from a foreign country or United States territory.
• A student moving to or from the place he or she attends school.
• A seasonal worker moving to or from the place he or she lives and works.
• Moving to or from a shelter or other transitional housing. Note: Starting July 2016, you must prove you had qualifying health coverage for one or more days in the 60 days before your move, unless you’re moving from a foreign country or United States territory. Also, moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.
4. Change in eligibility for Marketplace coverage or help paying for coverage You may qualify for a Special Enrollment Period if you (or anyone in your household):
• 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, U.S. national, or lawfully present individual.
• Become newly eligible for Marketplace coverage after being released from incarceration (detention, jail, or prison).
• Gain or maintain status as a member of a federally recognized tribe or Alaska Native Claim Settlement Act (ANCSA) Corporation shareholders (you 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 lived 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 (FPL).
