Special Enrollment Periods for complex issues
You can enroll in a private health plan through the Marketplace outside of Open Enrollment only if you qualify for a Special Enrollment Period.
You may qualify for a Special Enrollment Period if:
- You have a
- Your estimated household income is within a certain range.
- You have one of the special situations listed below.
You faced a serious medical condition, natural disaster, or other national or state-level emergency that kept you from enrolling on time. For example:
- An unexpected hospitalization or temporary cognitive disability, or were otherwise incapacitated
- A natural disaster, such as an earthquake, massive flooding, or hurricane
To qualify due to a natural disaster, you must live (or have lived during the event) in a county that is eligible to apply for "individual assistance" or "public assistance" by the Federal Emergency Management Agency (FEMA).
- You have 60 days from the end of the FEMA-designated incident period to complete your enrollment in Marketplace coverage.
- You can also ask to have your plan start date be when you would have picked a plan if not for the disaster.
- Get FEMA designation information for your area.
For help enrolling through this Special Enrollment Period, contact the Marketplace Call Center.
Enrollment or plan information display 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, or agent or broker) kept you from:
- Enrolling in a plan, or the right plan for you
- Getting the premium tax credit or cost-sharing reduction you qualified for
- A technical error happened when you applied on HealthCare.gov -- you probably saw an error message when completing your application – that prevented:
- You from enrolling in a plan, or
- Your health insurance company from getting your enrollment information
- The wrong plan information was displayed on HealthCare.gov at the time that you selected your health plan, such as benefit or cost-sharing information.
Becoming newly eligible for savings on a Marketplace plan
You previously lived in a state that hasn’t expanded Medicaid and weren’t eligible for Medicaid or a premium tax credit 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.
Found not eligible for Medicaid or CHIP coverage
You applied for Marketplace or Medicaid/CHIP coverage during Open Enrollment or with a different Special Enrollment period and were told you might be eligible for Medicaid/CHIP. But, when your state agency told you that you weren’t eligible, Open Enrollment or your Special Enrollment Period had already ended.
You may qualify for a Special Enrollment Period whether you applied through the Marketplace or your state Medicaid and CHIP agency directly.
Gaining or becoming a dependent due to a court order
You gained a new dependent or became a dependent of someone else due to a child support or other court order. Coverage starts the same day as the effective date of the court order – even if you enroll in the plan up to 60 days afterward.
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. You may be 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.
Successful appeal decision
If you filed an appeal with the Marketplace and the decision is in your favor, you’ll have the option to enroll in or change plans. You'll get a letter with the Marketplace Appeals Center's final decision that will explain any changes, how we made the decision, and your next steps.
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)
We'll ask for information about your situation to check if you qualify for a Special Enrollment Period. If you qualify, we'll 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 switch plans. In some limited cases, you may qualify for an earlier start date of coverage. Remember, you must make the first premium payment before your coverage starts.
Filing an appeal
If the Marketplace denies your request for a Special Enrollment Period, you can file an appeal. If your appeal is successful, you can get coverage back to the date your Special Enrollment Period was denied.