Understanding the Affordable Care Act’s Enrollment Periods

The ACA Open Enrollment Period is a special time each year when you can sign up for health insurance or change your current plan. This period usually lasts from November 1 to January 15, depending on the state. If you sign up by December 15, your new health plan will start on January 1 of the next year.

During Open Enrollment, you can buy a new health plan if you don't have one. If you already have a plan, you can change it to something that might work better for you. You can also switch insurance carriers. You can enroll through the Health Insurance Marketplace website, at Healthcare.gov, a state-based exchange, through a broker, or directly through most insurance companies.

The law also allows people to sign up for health insurance even if it’s not the usual time to do so. This is the Special Enrollment Period, which is a special time when you can get health insurance or change your health plan outside the normal enrollment period. It is typically because of a big change in someone’s life. The Special Enrollment Period is important because it helps people get health insurance when they need it the most. If something big happens in your life, like moving to a new place or having a baby, you can still get health insurance without having to wait until the next Open Enrollment Period. The Special Enrollment Period typically lasts for 60 days from the date of a qualifying life event. This means you have 60 days to enroll in a new health plan or make changes to your existing plan after the event occurs.

Qualifying life events are big changes in your life that let you sign up for health insurance during the Special Enrollment Period. Here are some examples:

Loss of Health Coverage

• Losing health insurance from a job (known as loss of minimum essential coverage)
• Losing Medicaid or the Children’s Health Insurance Program (CHIP)
• Losing pregnancy-related healthcare coverage
• Turning 26 and no longer being on your parent's plan
• Losing Medicaid for the medically needy

Changes in Household

• Getting married, divorced or entering a domestic partnership
• Having a baby, adopting a child, fostering a child, or placing a child for adoption
• A family member who was on your plan dies

Changes in Residence

• Moving to a new ZIP code, county or state
• Moving into or out of a shelter

Changes in Circumstances

• Losing or gaining eligibility for tax credits/subsidies for current health plan
• Offered an ICHRA (Individual Coverage Health Reimbursement Account) or QSEHRA (Qualified Small Employer HRA)
• Becoming a U.S. citizen
• Newly gaining eligible immigration status
• Getting out of jail
• Moving out of the Medicaid coverage gap

Other Situations

• Mandated to be covered as a dependent
• Current employer plan no longer considered qualifying employer coverage
• American Indian or Alaska Native (AI/AN)
• Resolving a data-matching issue (DMI)
• Error, misrepresentation, inaction, misconduct by Marketplace or HHS
• Plan or benefit display error
• Health plan violation by a Qualified Health Plan

To enroll during the Special Enrollment Period, you may need to provide documentation that shows proof of your qualifying life event. For example, you might need a marriage certificate if you got married, or a letter from your old job if you lost your job-based insurance.

During the Special Enrollment Period, you might get help paying for your health insurance with a premium tax credit and a cost-sharing reduction. Make sure to show your income and household size when you sign up.

Sometimes, the Open Enrollment Period can be longer, or the rules for the Special Enrollment Period can change. If you have questions about qualifying to purchase a plan, please contact us.