Can I Get Health Insurance Outside of Open Enrollment? Here’s What You Need to Know

What happens when Open Enrollment ends?

For Marketplace health insurance, Open Enrollment is the main annual window for enrolling in or changing a plan. HealthCare.gov currently lists the Open Enrollment Period as November 1 through January 15 each year.

If you are outside that window, you generally cannot simply sign up for a Marketplace plan whenever you want. Instead, you may need to qualify for a Special Enrollment Period because of a qualifying life event or another eligible circumstance.

There is an important exception: Medicaid and CHIP applications are available year-round. If you qualify for one of those programs, you can apply outside Marketplace Open Enrollment.

Employer-sponsored health plans can have their own enrollment rules and special enrollment periods, so someone who gets insurance through a job should also check with the employer or plan administrator.

What is a Special Enrollment Period?

A Special Enrollment Period is a period outside the yearly Open Enrollment window when you can enroll in or change a Marketplace plan because of a qualifying circumstance.

HealthCare.gov says the timing depends on the type of Special Enrollment Period. For many qualifying life events, you generally have a window that includes 60 days before or 60 days after the event, although the exact rule can vary.

For example, if you know your employer coverage will end soon, you may be able to apply before the loss of coverage rather than waiting until after you become uninsured. If you already lost coverage, the Marketplace generally gives you a limited period to select a plan.

Qualifying life events that may open a Special Enrollment Period

Qualifying life events, often called QLEs, are changes in your circumstances that can make you eligible to enroll outside Open Enrollment.

HealthCare.gov identifies several common categories:

• Losing health coverage: This can include losing job-based coverage, certain individual or student coverage, losing eligibility for Medicaid or CHIP, or turning 26 and aging off a parent's plan.
• Getting married: Marriage can create a Special Enrollment Period and may allow you to add coverage for yourself or your household.
• Having a baby or adopting a child: A birth, adoption, or placement for foster care can create a Special Enrollment Period. In certain circumstances, coverage can begin on the date of the event.
• Getting divorced or legally separated: This can qualify when the divorce or legal separation results in loss of health coverage.
• Moving: Moving to a new home in a different ZIP code or county can qualify, subject to Marketplace rules and other requirements.
• Other changes: Certain changes involving income, citizenship or immigration status, tribal membership, incarceration, service programs, or unexpected events can also qualify in specific circumstances.

Losing health coverage: what to know

Losing existing health insurance is one of the most common reasons people qualify for a Special Enrollment Period. HealthCare.gov says you may qualify if you or someone in your household lost qualifying health coverage in the past 60 days or expects to lose it in the next 60 days.

Examples can include losing coverage through an employer, losing coverage as a dependent, or losing eligibility for certain public programs. If you lost Medicaid or CHIP coverage, HealthCare.gov currently identifies a 90-day Special Enrollment Period window in many cases.

Timing matters. If you know your current coverage will end, do not wait until the last possible day to investigate your options. Applying early can help you understand your eligibility and avoid an unnecessary gap.

You may also be asked to provide documents showing that the qualifying event occurred. HealthCare.gov says that if documents are requested, you should submit them promptly because coverage cannot necessarily be used until eligibility is confirmed and required premium payments are made.

Medicaid and CHIP can be available year-round

If you do not qualify for a Marketplace Special Enrollment Period, that does not necessarily mean you have no options.

HealthCare.gov says you can apply for Medicaid or the Children's Health Insurance Program (CHIP) at any time of year. These programs provide free or low-cost coverage to eligible people, with eligibility rules that vary by state and individual circumstances.

Because Medicaid and CHIP are not limited to the annual Marketplace Open Enrollment window, they can be particularly important for people whose income or household situation changes after Open Enrollment ends.

If you recently lost Medicaid or CHIP, the Marketplace may also determine whether you qualify for a Special Enrollment Period and whether you may qualify for financial help with a Marketplace plan.

Other situations that may qualify

Special Enrollment Period rules are broader than the most familiar events like marriage or losing a job. HealthCare.gov lists additional circumstances that may create a SEP.

Examples can include becoming a U.S. citizen, gaining certain federally recognized tribal or Alaska Native status, leaving incarceration, starting or ending certain AmeriCorps service, and experiencing an unexpected and uncontrollable event such as a natural disaster that prevented you from enrolling.

There are also Special Enrollment Period rules for certain complex situations. Because these rules can be fact-specific, the safest approach is to check your eligibility through the Marketplace rather than assuming that an unusual circumstance either does or does not qualify.

What to do if you need health insurance right now

If Open Enrollment has ended and you need coverage, start by checking whether you qualify for a Special Enrollment Period or Medicaid/CHIP.

1. Identify what changed. Did you lose coverage, get married, move, have a baby, adopt a child, or experience another qualifying event?
2. Check the date. Many Special Enrollment Periods have strict time windows, so knowing exactly when the event happened or when coverage will end is important.
3. Apply through the Marketplace. HealthCare.gov can determine whether you qualify for a Special Enrollment Period and can also screen for Medicaid or CHIP.
4. Gather documentation. You may need proof of a coverage loss or another qualifying event.
5. Compare the actual plan costs. Look beyond the monthly premium and review deductibles, copayments, coinsurance, out-of-pocket maximums, provider networks, prescriptions, and coverage rules.
6. Confirm your effective date. Make sure you understand when the new plan begins and what you need to do to complete enrollment, including paying the first premium when required.

Frequently asked questions