What are special enrollment periods – and how could they help you enroll right now?
11 SEPs that allow you to get or change coverage outside of open enrollment
Published: 05/22/2025
If you need to buy your own ACA-compliant individual health insurance, your opportunity to purchase coverage is limited to the ACA’s annual open enrollment period, or a special enrollment period (SEP).
Open enrollment runs from November 1 to January 15 in most states. Once open enrollment ends, you won’t be able to enroll in coverage – or switch plans – for the rest of that year unless you qualify for an SEP. This is true regardless of whether you’re buying coverage in the health insurance Marketplace/exchange or purchasing it directly from an insurance company.
If a plan is available for purchase year-round – and no special enrollment period is necessary – it’s not compliant with the Affordable Care Act (ACA) and generally won’t provide comprehensive coverage.
What is a special enrollment period?
A special enrollment period is a window of at least 60 days when you can either enroll in coverage or switch to a different plan (some SEPs only allow an existing enrollee to switch to a different plan at the same metal level.)
In most cases, special enrollment periods are triggered by specific qualifying life events. Here’s a list of the reasons you might qualify for a special enrollment period for individual market health insurance:
- You lost other major medical health coverage. For example, you left your job and thus lost access to the employer-sponsored health coverage you had while working there, or you lost coverage due to a divorce or death. Your SEP starts 60 days before the loss of coverage and continues for 60 days after loss of coverage. (If the coverage you lost is Medicaid, the SEP will continue for 90 days in most states.)
- Your employer starts providing reimbursement for health insurance premiums. If your employer starts to reimburse employees for individual-market health insurance premiums using an ICHRA or QSEHRA, you’ll be eligible for an SEP so that you can obtain the necessary coverage or switch to a different plan. Your SEP can start up to 60 days before the reimbursement becomes available, and continues for 60 days after it becomes available.
- You’re subsidy-eligible and your income isn’t more than 150% of the poverty level. This SEP doesn’t require a specific qualifying life event, and it isn’t time-limited – eligible applicants can enroll year-round. It’s available in nearly every state (and at higher income limits in some states) and eligibility is based on household income. For 2025 coverage, 150% of the federal poverty level amounts to an income of $22,590 for a single individual in the continental United States.
- You get married, have a baby, or adopt or foster a child. The SEP starts on the date of marriage, birth, adoption, or foster placement, and continues for 60 days. In the case of marriage, at least one spouse must have had minimum essential coverage prior to the marriage. In the case of birth, there are several states where pregnancy triggers an SEP, but the SEP doesn’t begin in most states until the baby is born.
- You move to an area where different health insurance plans are available. Your SEP begins on the date of the move and continues for 60 days. This SEP is only available if you had minimum essential coverage prior to the move.
- Your eligibility for Marketplace subsidies changes. This includes becoming newly eligible or ineligible for premium subsidies or cost-sharing reductions. The change in eligibility could be due to a change in household income or household size. Your SEP starts when your subsidy eligibility changes, and continues for 60 days. In most cases, this SEP can only be used to switch from one plan to another. But for a person in the Medicaid coverage gap who becomes newly eligible for Marketplace subsidies, there’s no prior coverage requirement. (The Medicaid coverage gap exists in nine states as of early 2025).
- You gain U.S. citizenship or lawfully present immigration status. This SEP is available in the Marketplace but does not have to be offered by insurers outside the Marketplace. The SEP starts the day the citizenship or lawfully present status is obtained, and continues for 60 days. (Switching from one lawfully present status to another doesn’t trigger an SEP.)
- Your employer-sponsored health insurance becomes unaffordable or stops providing minimum value. The affordability of coverage is determined based on your household income, and minimum indicates the degree to which a plan is comprehensive. The SEP is only available in the Marketplace, and only if you’re newly eligible for subsidies due to the change in your employer-sponsored coverage. (Marketplace subsidies aren’t available when you have access to an employer-sponsored plan that’s considered affordable and provides minimum value.)
- Your non-calendar-year health plan is renewing. All ACA-compliant individual-market plans cover you for the calendar year and so do many employer-sponsored plans. But some pre-ACA individual-market plans and some employer-sponsored plans have plan years that end on a date other than Dec. 31. In that case, you can choose to not renew that coverage, and you’ll have an SEP to purchase a replacement plan. Your SEP starts 60 days before the renewal date of your current plan and continues for 60 days after the renewal date.
- You experience exceptional circumstances, including natural disasters. This encompasses a wide range of SEP opportunities, many of which are granted by the Marketplace on a case-by-case basis.
- You’re an American Indian or Alaska Native. You can enroll anytime, year-round. If your household income isn’t more than 300% of the federal poverty level, you’ll qualify for a plan with zero out-of-pocket costs.
Why are special enrollment periods necessary?
Limiting sign-ups to an annual open enrollment period and special enrollment periods is necessary when health plans cover pre-existing conditions and are guaranteed-issue (meaning applicants can’t be rejected due to their medical history).
The federal government has adjusted and optimized SEPs for individual-market coverage over the years to ensure that people can enroll or make a plan change when necessary, while also protecting the sustainability of the insurance market.
What will I need to prove my eligibility for an SEP?
If you experience a qualifying life event, you may need to provide proof of it in order to get an SEP. The most commonly used SEP is for loss of other coverage, and HealthCare.gov does require proof of the loss of other coverage.
Washington, DC and 19 states run their own Marketplaces and can require proof of qualifying events for any or all SEPs.
If the SEP you’re using requires that you had minimum essential coverage in place before the qualifying life event (for example, marriage or a permanent move), you will also need to provide proof of the coverage you had.
The requirements for SEP eligibility verification have changed over the years. They could change again in the future under the federal rulemaking process.
