What Qualifies You for Major Medical Outside of Open Enrollment?

_{Did you know certain qualifying life events will allow you a special enrollment period? See if you can still enroll in Major Medical.}  

It’s that time of year again: open enrollment for the Affordable Care Act (ACA) typically runs from November 1st until January 15th. If you have an ACA plan, that means you’ll likely be bombarded with texts, emails, and calls to be sure you’ve chosen next year’s plan. There’s a reason why the agents working for Healthcare.gov are so thorough during this season. After open enrollment ends, you can’t just waltz in and sign up for a Marketplace healthcare plan whenever it is convenient for you. 

But, certain qualifying life events will allow you a special enrollment period (SEP) in which you can choose a Marketplace plan outside of the open enrollment period. Usually a special enrollment period is a sixty-day window starting on the day of the qualifying life event to enroll.

So what counts as a qualifying life event? 

1. Losing your job-related health insurance. It doesn’t matter if you are fired or if you quit.
2. Losing your individual health plan, such as a plan being discontinued or losing eligibility for a student plan.
3. Your household income decreased, making you newly eligible for a marketplace plan.
4. Death of a family member that results in the loss of your health coverage.
5. Getting married.
6. Turning 26 and no longer being eligible for your parents’ plan.
7. Having a baby, adopting a child, or having a child placed in foster care.
8. Divorce that results in loss of health coverage.
9. Moving to a new ZIP code within the US.
10. Moving to the US from abroad.
11. Moving to or from school if you are a student.
12. Moving to or from transitional housing.
13. Moving for seasonal work.
14. Getting offered an HRA or QSEHRA Qualified Small Employer Health Reimbursement Arrangement. 
15. Leaving incarceration.
16. Becoming a US citizen.
17. Losing or being denied Medicaid or CHIP coverage because:
    1. Your household income changed.
    2. Your child aged out of CHIP.
    3. Open Enrollment ended during an appeal when you were told you weren’t eligible for Medicaid/CHIP, but you were.

This is not a full list of reasons why you may be eligible for a special enrollment period. A comprehensive list is available at Healthcare.gov. The special enrollment factsheet is a one-stop place to find the answers to your questions.

For more information, this article from eHealth has a helpful breakdown of qualifying life events and cute infographics to help you understand if your life event qualifies you for special enrollment. 

Remember, if none of the above events apply to you and you get your health insurance plan through the ACA, you must apply for your new plan before open enrollment ends on January 15, 2024. You may be automatically set up to roll over to your same plan next year, but always double check to ensure you are covered.