How can I get coverage outside of open enrollment?
You can apply to the Marketplace any time outside open enrollment. But the coverage you can get depends on your situation and the coverage you qualify for.
- Outside open enrollment, you can enroll in a private insurance plan through the Marketplace only if you have certain life events that give you a special enrollment period.
- You can apply for Medicaid or the Children’s Health Insurance Program (CHIP) any time and you can enroll right away.
Buying a Marketplace plan outside open enrollment
In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event. Qualifying life events that create a special enrollment period include:
- Getting married
- Having, adopting, or placement of a child
- Permanently moving to a new area that offers different health plan options
- Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
- For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions
Special enrollment periods
If you have a qualifying life event, you get a special enrollment period. This means you can enroll in or change your health insurance plan outside the open enrollment period.
Most special enrollment periods last 60 days from the date of the qualifying life event.
Open enrollment for Marketplace coverage ends March 31, 2014. The next proposed open enrollment period is November 15, 2014 - January 15, 2015.
Medicaid and CHIP: Enroll any time
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time—there is no open enrollment period for these programs. Medicaid and CHIP provide health coverage to millions of families with limited incomes.
You can find out if you qualify for Medicaid or CHIP by filling out a Marketplace application or going directly to your state Medicaid agency.
Some states have expanded their Medicaid programs this year. If your state has expanded Medicaid, you’ll probably qualify if your income is below about $15,800 for an individual or $32,500 for a family of 4. See if your state is expanding Medicaid.
If your state isn’t expanding Medicaid you may still be eligible, especially if you have children, are pregnant, or have a disability. Every state’s eligibility rules are different. If it looks like you’re eligible for Medicaid or CHIP, the Marketplace will pass along your information to your state agency, where you’ll be able to enroll.
Find contacts for your state’s Medicaid and CHIP programs.
More Answers: Special Enrollment Periods
What if my income increases and I lose Medicaid coverage?
You qualify for a special enrollment period because you’re losing other health insurance coverage.
What if my income changes and I either lose or gain eligibility for lower costs on insurance based on my income?
As long as you’re already enrolled in a Marketplace plan you qualify for a special enrollment period because your household income or size has changed.
What if my child ages off the Children’s Health Insurance Program (CHIP)?
Your child qualifies for a special enrollment period because he or she is losing other health insurance coverage.
What if I turn 26 and can no longer be on a parent’s plan?
You qualify for a special enrollment period because you’re losing other health insurance coverage.
My current insurance plan expires in 2014, outside of the open enrollment period. Can I sign up for coverage at that time?
Yes. If you bought or renewed a plan in 2013 that ends in 2014, you’ll get a special enrollment period when that policy ends to buy new coverage for you and your family.
The special enrollment period begins 30 days before your plan ends in 2014. You have up to 60 days to enroll in coverage, either inside or outside of the Marketplace.
To avoid a gap in coverage, enroll in a new plan by the 15th of the last month of your current plan’s coverage.
If you miss this special enrollment period, you may have to wait until the next open enrollment period in November 2014 to buy coverage.
My individual or job-based insurance is too expensive. Can I switch to a Marketplace plan outside the open enrollment period?
Voluntarily leaving your health insurance plan doesn’t qualify you for a special enrollment period. Only if you lose coverage do you do get a special enrollment period.
If you’re enrolled in job-based insurance, and the coverage doesn’t meet certain standards, you may be eligible for a special enrollment period. Learn about these standards in the section of this page titled “Qualifying for Marketplace Savings.”
