Elegibility Parameters

Special Enrollment Period
by Changes in Household Size

You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:

Got married: Pick a plan by the last day of the month and your coverage can start the first day of the next month.

Had a baby, adopted a child, or placed a child for foster care: Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.

Got divorced or legally separated and lost health insurance: Please note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.

Death: You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

Elegibility Parameters

Special Enrollment Period
More Qualifying Changes

Other life circumstances that may qualify you for a Special Enrollment Period are:

Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

New Citizenship. Becoming newly eligible for Marketplace coverage because you became a U.S. citizen.

Freedom. Leaving incarceration.

AmeriCorps VISTA members starting or ending their service

Elegibility Parameters

Special Enrollment Period
Other Qualifying Changes

Other life circumstances that may qualify you for a Special Enrollment Period are:

Experience domestic abuse/violence or spousal abandonment. You're a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner. Your dependents may be eligible too. If you’re married to your abuser/abandoner, you can answer on your Marketplace application that you’re unmarried, without fear of penalty for mis-stating your marital status. You then become eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income. If you qualify for this cause you'll have 60 days to enroll in a Marketplace plan.

Enrollment errors Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, navigator, certified application counselor, agent or broker) kept you from enrolling in a plan, enrolling in the right plan, or getting the premium tax credit or cost-sharing reduction you were eligible for.

System glitch: A technical error occurred when you applied yourself online - you probably saw an error message when completing your application – that prevented you from enrolling in a plan, or your health insurance company from receiving your enrollment information.

The wrong plan data was displayed online at the time that you selected your health plan, such as benefit or cost-sharing information.

Wrong State. You previously lived in a state that hasn’t expanded Medicaid and weren’t eligible for Medicaid or advance payments of the premium tax credit (APTC) because your income was too low. But in the last 60 days, you had an increase in household income or moved, making you newly eligible for premium tax credits.

Being determined ineligible for Medicaid or CHIP. You applied for Medicaid or CHIP during the Marketplace Open Enrollment Period and your state Medicaid or CHIP agency determined that you weren’t eligible for Medicaid or CHIP after Open Enrollment ended. You may qualify for a Special Enrollment Period regardless of whether you applied through:
-The Marketplace and your information was sent to your state Medicaid or CHIP agency, or
-Your state Medicaid or CHIP agency directly.

Gain or become a dependent due to a child support or other court order. You gained a new dependent or became a dependent of someone else due to a court order. Your coverage would start the effective date of the court order – even if you enroll in the plan up to 60 days afterward.

Prevail on Appeal. You believe you received an incorrect eligibility determination or an incorrect coverage effective date and file an appeal with the Marketplace. If the ruling goes in your favor, you’ll be given the option to enroll in or change plans either retroactively or prospectively.