Understanding Special Enrollment Periods: Your Guide to Getting Coverage Outside Open Enrollment

What is a Special Enrollment Period?

A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance or change your existing plan. These periods are triggered by specific life events, called qualifying life events (QLEs), and typically last for 60 days from the date of the event.

Qualifying Life Events

Here are the most common life changes that may qualify you for a Special Enrollment Period:

• Loss of Health Coverage

  • Losing job-based coverage
  • Losing individual health coverage
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Losing coverage through a family member

• Changes in Household

  • Getting married
  • Having a baby or adopting a child
  • Divorce or legal separation
  • Death in the family

• Changes in Residence

  • Moving to a new ZIP code or county
  • Moving to or from school
  • Seasonal workers moving for work
  • Moving to or from a shelter or transitional housing

How Long Do You Have to Enroll?

In most cases, you have 60 days from the date of the qualifying life event to enroll in a new health insurance plan or make changes to your existing coverage. It's important to note:

• The 60-day window applies both before and after certain qualifying events
• Missing this window means waiting until the next Open Enrollment Period
• Documentation of your qualifying event will be required

Required Documentation

When applying for coverage during a SEP, you'll need to provide documentation to prove your qualifying event. Common documents include:

• Letter of coverage termination from your insurance company
• Marriage certificate
• Birth certificate or adoption papers
• Proof of address change
• Letter of job loss or reduction in hours

Special Considerations for 2025

For 2025, there are some important updates to Special Enrollment Period rules:

• Enhanced verification process for qualifying life events
• Extended enrollment windows for certain qualifying events
• New qualifying events related to public health emergencies
• Additional flexibility for low-income households