Outside the Open Enrollment Period, you can enroll in a private health plan through the Marketplace only if you qualify for a Special Enrollment Period.
You can qualify for a Special Enrollment Period if either of the following applies to you:
Below are cases and examples that may also qualify you for a Special Enrollment Period:
You faced a serious medical condition or natural disaster that kept you from enrolling. For example:
You live in a state that hasn’t expanded Medicaid and weren’t eligible for Medicaid or advance payments of the premium tax credit (APTC) when you first applied because your income was too low. But in the last 60 days, you had a change in household income that makes you newly eligible for premium tax credits.
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:
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.
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. You can enroll by contacting the Marketplace Call Center. 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 SEP, you'll have 60 days to enroll in a Marketplace plan.
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.
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)
The representative will ask for information about your situation to determine if your circumstances qualify you for a Special Enrollment Period. The representative will help you apply and enroll in coverage.
If you’re already enrolled in a plan and you get a Special Enrollment Period, you can stay in your current plan in most cases, or you can switch plans. In some limited cases, you may qualify for an earlier effective date of coverage. Remember, you must make the first premium payment before your coverage becomes effective.
If your request for a Special Enrollment Period is denied, you can file an appeal. If the denial is found incorrect, you can get coverage back to the date your Special Enrollment Period was denied.
How to file an appeal:
When possible, include a copy of any eligibility determination notice or other official notice you received. This isn’t required, but will help us process your appeal.
When mailing the appeal request to the Health Insurance Marketplace, be sure to include the last 4 digits of the London, KY ZIP code (40750-0061). This will help your appeal arrive faster.