A special enrollment period allows you to enroll in an ACA-compliant plan (on or off-exchange) if you have a qualifying life event. Normally, coverage is only available for purchase during the annual open enrollment period, but a special enrollment period allows people to sign up for coverage outside of that annual window, as long as they have a qualifying event.
Read more about special enrollment periods, and see detailed descriptions of each of the qualifying events that trigger special enrollment periods in our guide to special enrollment periods.
In the case of involuntary loss of coverage, the special enrollment period begins in advance of the loss of coverage so that enrollees can purchase a new plan with no gap in coverage. The rest of the qualifying events trigger a special enrollment period that begins on the date of the qualifying event and continues for 60 days. In most cases, the earliest that coverage can take effect is the first of the month after the enrollment is completed. But if the qualifying event is the birth or adoption of a child, coverage can be backdated to the birth/adoption date.
If you do not qualify for a special enrollment period, you can only enroll in an ACA-compliant plan (on or off-exchange) during the regular annual open enrollment period.
But some special enrollment periods do not require a specific qualifying life event. For example, Native Americans can enroll through the exchange anytime. And there’s also an ongoing special enrollment period for subsidy-eligible enrollees whose household income doesn’t exceed 150% of the poverty level.
Are special enrollment periods the same for employer-sponsored and individual coverage?
Most of the qualifying life events that apply to employer-sponsored plans are similar to the qualifying events that trigger a special enrollment period in the individual market, but there are some differences. And special enrollment periods for employer-sponsored plans generally only last 30 days, as opposed to 60 days for individual market plans.
If you have access to an employer’s plan and you experience a qualifying life event, it will give you an opportunity to enroll in the employer’s plan, or make changes to your coverage, including disenrollment (for individual market plans, a qualifying event is not necessary to disenroll outside of open enrollment, but that’s not the case for employer-sponsored coverage)
