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7 Life Events That Qualify You for Special Enrollment Period

Healthcare Personal Finance
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Updated for 2024.

Under the Affordable Care Act, you can usually only buy a health insurance plan, apply for subsidies to help pay for coverage or switch plans during the annual open enrollment period. The purpose of this rule is to keep people from waiting until they are sick or suspect they may be ill to purchase health insurance.

If you don’t have health coverage, the next time you can purchase it from the healthcare.gov marketplace will be during the next open enrollment period, which runs from Nov. 1, 2024, to mid-January 2025 (the exact dates depend on which state you live in).

While the open enrollment period for 2024 health insurance coverage has passed, you may still be able to qualify for a special enrollment period if you experienced a qualifying life event. In this case, you generally have 60 days from the event date to purchase marketplace insurance. Here are seven of the most common qualifying events and life changes that impact special enrollment period eligibility.

1. Leaving your job (or involuntary loss of health coverage)

If you have insurance and lost it involuntarily, you can qualify for a special enrollment period. A common example of this would be leaving a job and losing your job-based healthcare coverage.

If you apply for insurance through the health insurance marketplace, keep in mind that a change in income may mean you can receive a subsidy that covers all or most of your health insurance premium. However, be aware that if your total income for the year is higher than you estimated when applying for the subsidy, you may have to pay back some or all of the tax credit when you file your taxes.

Another option is to stay on your employer’s policy under COBRA. However, if you sign up for COBRA and decide to cancel it before it ends, you do not get another special enrollment period.

2. Getting married

When you get married, you may qualify for a special enrollment period. You have 60 days from your wedding date to buy health insurance, change to a different health plan or add your spouse to your existing plan.

To qualify for special enrollment, you or your spouse must have health coverage for at least one of the 60 days before the marriage. If neither of you had minimum essential coverage during this time, you could not use marriage as a qualifying life event to enroll in a new health plan. If you’re eligible for special enrollment, your policy becomes effective the first of the month following your application.

3. Getting divorced

If you’ve been getting health insurance through your spouse’s policy and get a divorce, you have 60 days to find a new plan (through the marketplace or privately) during your special enrollment period in most states. Assuming your income is lower as a single person, you may qualify for a full or partial subsidy for your health insurance premiums.

4. New dependents

If you recently gained a dependent — perhaps through birth, adoption or foster care placement — you qualify for a special enrollment period. You can also be eligible if your parent or another dependent family member comes to live with you. In the case of a new dependent, you have a 60-day window to add that person to your policy or change policies. If you didn’t have health insurance when you added the dependent, you can also purchase it during this period.

5. A permanent move

Moving doesn’t automatically qualify you for a special enrollment period. For example, if you simply move a few blocks away, it’s not a qualifying life event. However, most health insurance plans are specific to a particular geographic area. If you move out of the area currently served by your plan, even if it’s within the same state, you have 60 days to find a new policy.

To qualify for special enrollment after a move, you must have had minimum coverage for at least one of the 60 days before the move. There are some exceptions, though, including if you are moving to the U.S. from abroad or were recently released from incarceration.

Tip: If you own and live in homes in multiple states during the year, you can switch policies when moving between them. However, be aware that your deductible may reset if you change plans mid-year. A nationwide plan may be a beneficial alternative in this instance if it’s available to you.

6. Change in citizenship status

Becoming a U.S. citizen or legal immigrant in the U.S. during the year can also be a qualifying life event for special enrollment. As a U.S. citizen or legal immigrant, you can buy health insurance through a government-sponsored marketplace, and you may even qualify for subsidies to help offset the cost of premiums.

7. Leaving incarceration

Leaving jail or other incarceration qualifies for a special enrollment period, during which time you can purchase health insurance.

Is there still a penalty for not having health coverage?

Most states no longer impose a penalty for those who do not have health insurance — this mandatory penalty was eliminated under the Tax Cuts and Jobs Act of 2017. Only California, Massachusetts, New Jersey, Rhode Island and Washington, D.C., have penalties for non-compliance in 2024.

Is there a way to get healthcare coverage if I missed open enrollment and don’t qualify for a special enrollment period?

If you don’t qualify for a special enrollment period but want to enroll in a health plan outside of the open enrollment period, you can apply for a short-term health insurance plan. A short-term plan is only temporary and does not cover pre-existing conditions.

Remember, you can also enroll in state Medicaid coverage or the Children’s Health Insurance Program (CHIP) any time of year — you don’t have to wait for an open enrollment period.

This article is for informational purposes only and not legal or financial advice.

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