Getting health coverage outside Open Enrollment

Enroll in or change 2020 plans — only with a Special Enrollment Period

If you don’t qualify for a 2020 Special Enrollment Period, you can enroll in any 2021 health plan right now. Coverage starts January 1, 2021.

Life changes that can qualify you for a Special Enrollment Period

Changes in household

You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:

  • Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
  • Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Died. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

Changes in residence

Household moves that qualify you for a Special Enrollment Period:

  • 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
  • If you're a student, moving to or from the place you attend school
  • If you're a seasonal worker, moving to or from the place you both live and work
  • Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don't need to provide proof if you’re moving from a foreign country or United States territory.

Loss of health insurance

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days (or more than 60 days ago but since January 1, 2020) OR expects to lose coverage in the next 60 days.

Coverage losses that may qualify you for a Special Enrollment Period:

Losing job-based coverage

You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if you lose health coverage through a parent or guardian because you're no longer a dependent.

Important: Voluntarily dropping coverage you have as a dependent doesn't qualify you for a Special Enrollment Period unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.
Losing individual health coverage for a plan or policy you bought yourself

You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:

  • Your individual plan or your Marketplace plan is discontinued (no longer exists).
  • You lose eligibility for a student health plan.
  • You lose eligibility for a plan because you no longer live in the plan’s service area.
  • Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.
  • Your household income decreased, and now you qualify for savings on a Marketplace plan.

Important: Losing individual coverage doesn’t qualify you for a Special Enrollment Period if you lose coverage because you didn’t provide required documentation when the Marketplace asked for more information.

Losing eligibility for Medicaid or CHIP

You may qualify for a Special Enrollment Period if you lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because:

  • You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.
  • Your child ages off CHIP.
Losing eligibility for Medicare

You may qualify for a Special Enrollment Period if you become no longer eligible for premium-free Medicare Part A.

You don’t qualify for a Special Enrollment Period if:

  • You lose Medicare Part A because you didn’t pay your Medicare premium.
  • You lose Medicare Parts B, C, or D only.
Losing coverage through a family member

You may qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen if:

  • You turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent’s health plan.
  • You lose job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for dependents.
  • You lose health coverage through a spouse due to a divorce or legal separation.
  • You lose health coverage due to the death of a family member.
  • You lose health coverage through a parent or guardian because you’re no longer a dependent.
Important: Voluntarily dropping coverage you have as a dependent doesn't qualify you for a Special Enrollment Period unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.

An employer offer to help with the cost of coverage

You may qualify for a Special Enrollment Period if you or anyone in your household newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days OR expects to in the next 60 days.

Note: Your employer may refer to an individual coverage HRA by a different name, like the acronym “ICHRA.”

Generally, you’ll need to apply for and enroll in individual health insurance before your individual coverage HRA or QSEHRA starts. However, your employer may offer different options for when your individual coverage HRA or QSEHRA can start so you have more time to enroll. Contact them or check the notice you got from your employer for more information. If you’re currently enrolled in a Marketplace plan with savings, these savings may change because of the help you get through a job. Get more information on how your savings may change if you have an individual coverage HRA or QSEHRA offer.

If you qualify to enroll in Marketplace coverage through this Special Enrollment Period, call the Marketplace Call Center to complete your enrollment. You can’t do this online.

More qualifying changes

Other life circumstances that may qualify you for a Special Enrollment Period:

  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

Learn about Special Enrollment Periods for complex issues.

More answers: Enroll in or change 2020 plans — only with a Special Enrollment Period

What if I’m turned down for a Special Enrollment Period, but I think I qualify?

You can appeal the decision. Learn how to appeal the decision to deny you a Special Enrollment Period.

What if something outside my control prevented me from getting coverage during the Open Enrollment Period?

In a few very limited situations, you could qualify for a Special Enrollment Period. Learn about Special Enrollment Periods for complex issues.