Special Enrollment Periods for Complex Health Care Issues | HealthCare.gov
You can enroll in a private health plan through the Marketplace outside of open enrollment only if you qualify for a special enrollment period.
You may qualify for a special enrollment period if:
Reading: How to get health insurance out of open enrollment
- have a , such as having a baby, getting married, moving, or losing minimum health coverage (such as coverage through your job, Medicaid, or the Children’s Health Insurance Program (CHIP)).
- Your estimated household income is within a certain range.
- you have one of the special situations listed below.
- an unexpected hospitalization or temporary cognitive impairment, or were otherwise incapacitated
- a natural disaster, such as an earthquake, massive flood, or hurricane
- You have 60 days from the end of the fema-designated incident period to complete your enrollment in Marketplace coverage.
- You can also request that your plan start date be when you would have chosen a plan had it not been for the disaster.
- learn about the fema designation for your area.
- misinformation, misrepresentation, misconduct, or inaction by someone working in an official capacity to help you enroll (such as an insurance company, navigator, certified application counselor, or agent or broker) prevented you from:
- enrolling in a plan, or the plan that’s right for you
- get the premium tax credit or cost-sharing reduction you qualified for
- a technical error occurred when you applied to healthcare.gov (you probably saw an error message when completing your application) that prevented you from:
- enrolling in a plan, or
- Your health insurance company obtains your enrollment information
- incorrect plan information was displayed on healthcare.gov at the time you selected your health plan, such as benefit or cost-sharing information.
newly eligible for savings on a marketplace plan
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You previously lived in a state that hasn’t expanded Medicaid and you weren’t eligible for Medicaid or a premium tax credit because your income was too low. but in the last 60 days, he had an increase in household income or moved, making him eligible for premium tax credits.
not eligible for medicaid or chip coverage
Applied for Marketplace or Medicaid/Chip coverage during open enrollment or a different Special Enrollment Period and was told you may be eligible for Medicaid/Chip. but, by the time your state agency told you you were ineligible, your open enrollment or special enrollment period had already ended.
You may qualify for a special enrollment period whether you applied through the Marketplace or from your state Medicaid & CHIP agency directly.
gain or become a dependent due to a court order
acquired a new dependent or became a dependent of another person due to a child support order or other court order. coverage begins the same day as the effective date of the court order, even if you join the plan up to 60 days later.
domestic abuse/spousal violence or abandonment
You are a survivor of domestic abuse/violence or spousal abandonment and wish to enroll in your own health plan separate from your abuser or abandonment. your dependents may also be eligible.
If you are married to your abuser/abandoner, you can answer on your Marketplace application that you are not married. You may be eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income.
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If you qualify for this period, you’ll have 60 days to enroll in a Marketplace plan.
successful appeal decision
If you filed an appeal with the Marketplace and the decision is in your favor, you will have the option to enroll or change plans. You will receive a final decision letter from the Marketplace Appeals Center that will explain any changes, how we made the decision, and your next steps.
if you think you qualify for a special enrollment period
contact the marketplace call center at 1-800-318-2596 (tty: 1-855-889-4325)
We will ask you for information about your situation to see if you qualify for a special enrollment period. If you qualify, we’ll help you apply and enroll in coverage.
If you’re already enrolled in a plan and get a special enrollment period, you can stay in your current plan (in most cases) or switch plans. in some limited cases, you may qualify for an earlier coverage start date. Remember, you must make your first premium payment before your coverage begins.
filing an appeal
If the Marketplace denies your request for a special enrollment period, you can file an appeal. If your appeal is successful, you can get coverage back as of the date your special enrollment period was denied.
Learn more about appeals and how to file them.
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Learn more about your coverage options.
unexpected situations
had a serious medical condition, natural disaster, or other state or national emergency that prevented you from enrolling on time. for example:
To qualify due to a natural disaster, you must live (or have lived during the event) in a county that is eligible to apply for “individual assistance” or “public assistance” from the federal emergency management agency (fema ).
For help enrolling during this special enrollment period, please contact the Marketplace call center.
