What is a Special Enrollment Period for Health Insurance?

  • September 13, 2016
  • |Quartz
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Find out what a Special Enrollment Period for health insurance is and the circumstances that qualify for one.
Not sure what a Special Enrollment Period for health insurance is? Click here to learn what it is and how to qualify for one.

When the Affordable Care Act became law, it restricted when people can sign up for individual health insurance. Each year, for a period of about three months, people can sign up for individual health insurance. This is called Open Enrollment. Individuals can’t buy health insurance any other time during the year, unless you qualify for a Special Enrollment Period (SEP).

A Special Enrollment Period for health insurance is limited to a qualifying life event or certain types of complicated situations.

Qualifying life events that create Special Enrollment Periods include –

  • Moving to a new permanent residence outside of your insurance coverage area
  • Having a baby, adoption or having a child placed with you for adoption or foster care
  • Getting married
  • New citizenship in the US
  • Aging off your parent’s plan (usually that’s when you turn 26)
  • Leaving incarceration
  • Having a change in income status that affects eligibility for premium tax credits or cost-sharing reductions

See a complete list of qualifying events here.

A Special Enrollment Period to buy individual health insurance outside of Open Enrollment may be available for those with certain complex issues as well. Examples of these special circumstances include –

  • Being unexpectedly hospitalized so that you couldn’t buy health insurance during Open Enrollment
  • You were involved in a major natural disaster, such as a flood, hurricane or an earthquake and were not able to buy health insurance during Open Enrollment
  • A health insurance advisor (not employed by the Health Insurance Marketplace) provided misinformation that caused you to miss enrollment, enroll in the wrong plan, or not get the subsidies you were entitled to receive
  • You were a victim of domestic abuse or abandonment and you have a need to buy your own plan

In addition, certain technical issues may also result in a Special Enrollment Period, such as technical errors by the insurance company during enrollment, system errors related to immigration status and technical glitches on the Health Insurance Marketplace website.

It’s important to know that Special Enrollment Periods last for a limited amount of time, usually 60 days. If you wait too long after a qualifying event, you may not be able to enroll in a health insurance plan. Go to healthcare.gov to see if you may qualify to enroll in health insurance in Wisconsin with a Special Enrollment Period.


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