Guides · Health insurance

Special enrollment period: who qualifies and how it works

A Special Enrollment Period lets you enroll in or change a Marketplace health plan outside Open Enrollment, usually within 60 days of a qualifying life event such as losing health coverage, moving, getting married or having a baby.

If you don't have a qualifying event, you'll generally wait for the next Open Enrollment. Medicaid and CHIP are different: you can apply any time of year.

Updated · Facts checked against the sources listed below

Qualifying life events

Not a complete list. Moving only for medical treatment or a vacation doesn't qualify. If a plan ends your coverage because you didn't pay premiums, that doesn't qualify either.
TypeExamples from HealthCare.gov
Losing health coverageJob-based coverage (including COBRA ending), individual coverage, Medicaid or CHIP, Medicare Part A, a parent's or spouse's plan. Also being offered an employer HRA or QSEHRA.
Household changesMarriage; having or adopting a child or placing a child in foster care; divorce or legal separation with lost coverage; a death that ends your coverage.
MovingTo a new ZIP code or county, to the U.S. from abroad or a U.S. territory, or to or from school, seasonal work or a shelter.
OtherBecoming a U.S. citizen, leaving incarceration, gaining membership in a federally recognized tribe, starting or ending AmeriCorps service, or a natural disaster.

The 60-day window and when coverage starts

  • Losing coverage: for most types, you can enroll in the 60 days after you lose it or the 60 days before you expect to lose it. Applying early helps you avoid a gap.
  • COBRA: you have 60 days to enroll after COBRA coverage runs out. Dropping COBRA on purpose outside Open Enrollment generally doesn't qualify.
  • Lost Medicaid or CHIP: HealthCare.gov says you may qualify if you lost it in the past 90 days.
  • Marriage: pick a plan by the last day of the month and coverage starts the first of the next month.
  • Birth, adoption or foster placement: coverage can start the day of the event, even if you enroll up to 60 days later.
  • When coverage starts after a loss: if you already lost job-based coverage, your Marketplace plan starts the first of the month after you pick it. For example, lose coverage March 7, pick a plan by March 31, and coverage starts April 1. Apply before the old coverage ends to avoid a gap.

Documents you may need

The Marketplace may ask you to prove the event. For loss of coverage, documents must show the coverage you lost and the date it ended, such as a letter from your employer or insurer. After you pick a plan, you have 30 days to send them, and you can't use the coverage until your eligibility is confirmed and your first premium is paid.

  • Upload scanned copies or clear photos (.pdf, .jpg, .png and other common formats) in your Marketplace account.
  • If you mail them, send photocopies only, never originals.
  • If the Marketplace can't confirm your eligibility, you'll get a letter explaining why and can send different documents.

Income changes and Medicaid

If you already have a Marketplace plan, update your application as soon as possible when your income or household changes, so your savings stay accurate. If a change makes you newly eligible for extra savings, you can switch to a Silver plan to use them. For most other Special Enrollment Periods, people already enrolled can only pick a new plan in the same metal category. The low-income Special Enrollment Period (for incomes up to 150% of the poverty level) is not available: CMS says Marketplaces will continue to be barred from offering it after the 2026 plan year.

You can apply for Medicaid or CHIP any time, all year, through the Marketplace application or your state Medicaid agency.

Gabriel can quote Marketplace plans for your ZIP code and household once you have a Special Enrollment Period, and open your own application with a licensed agent in most states. You choose the plan and finish the application.

Gabriel is not an insurer. Health insurance quotes and enrollment are handled by Gabriel Labs, Gabriel's separately licensed insurance agency. Gabriel membership is not health insurance and doesn't count as a qualifying plan.

Common questions

Does losing my job count as a qualifying life event?

Losing job-based health coverage does. You can usually enroll within 60 days after losing it, or up to 60 days before if you know it's ending.

How long is a special enrollment period?

Usually 60 days from the qualifying event. Some events, like losing Medicaid or CHIP, have a longer window.

Can I drop COBRA and get a Marketplace plan?

When your COBRA runs out, you have 60 days to enroll. Choosing to end COBRA early outside Open Enrollment generally doesn't give you a Special Enrollment Period. See COBRA insurance.

Do I need proof of my life event?

You may. After you pick a plan, you have 30 days to send documents, and coverage can't be used until they're accepted.

Can I sign up for Medicaid outside open enrollment?

Yes. HealthCare.gov says you can apply for Medicaid and CHIP any time of year.

Sources

  1. Special Enrollment Period (SEP) HealthCare.gov
  2. Confirming your Special Enrollment Period eligibility HealthCare.gov
  3. Getting Medicaid and CHIP HealthCare.gov
  4. HHS Notice of Benefit and Payment Parameters for 2027 Final Rule CMS
  5. Reporting income and household changes HealthCare.gov
  6. If you lose job-based health insurance HealthCare.gov
  7. Changing plans after a Special Enrollment Period HealthCare.gov
  8. Premium payments, grace periods and losing coverage HealthCare.gov

This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.