The Open Enrollment Period for an Affordable Care Act (ACA) health insurance plan runs each year from November 1 to January 15 in most states.¹ But if you miss the deadline, you may still be able to enroll in a plan if you qualify for a Special Enrollment Period (SEP).

“SEPs occur when there’s a life event where your situation dramatically changes,” says David Anderson, assistant professor in the department of Health Services, Policy and Management at the University of South Carolina’s Arnold School of Public Health.

So how do you qualify for an SEP? In general, you need to:¹

• Have had a qualifying life event (QLE), such as getting married, having a baby or losing your health coverage²
• Have proof of the event
• Apply for insurance within 60 days of it happening (in some cases, you also have 60 days before the event to apply)

Note: If you’re a Native American or an Alaskan Native member of a federally recognized tribe, you can sign up for marketplace coverage anytime.³

If you don’t qualify for an SEP, alternatives like Medicaid or CHIP may help provide coverage. Here are answers to some of the most common questions about Special Enrollment Periods (SEPs).

Miss the ACA annual Open Enrollment period and don’t qualify for an SEP? Learn how a short term health insurance plan could provide temporary healthcare coverage.

1. What counts as a qualifying life event for ACA Marketplace health insurance plans?

A qualifying life event (QLE) is a change in your situation, such as losing your health coverage, a change in household size or a move.²

Some QLEs include:²

• You lose your job (and your health insurance with it)
• You get married (at least one spouse typically needs to have had healthcare coverage before the wedding)
• You get divorced or legally separated (and lose your coverage)
• You have a baby or adopt a child
• Someone on your health insurance policy dies
• You move to a new home in an area where different health plans are available (as long as you had coverage before the move)
• You turn 26 (the age at which you’re taken off your parents’ health plan)
• Changes in your income that affect the coverage you qualify for (such as becoming eligible for Marketplace savings)
• You become a U.S. citizen

But other more complicated situations may also apply. For example, you may qualify for an SEP if something outside of your control — say, a house fire, an illness or a natural disaster — kept you from signing up during the annual ACA Open Enrollment Period.^1,4

Another rare but possible option: If a technical error kept you from being able to enroll, or if you were given the wrong information about the details of your plan — for example, the website incorrectly stated that a certain provider was in network — that counts too, says Caitlin Donovan, senior director at the National Patient Advocate Foundation.

When signing up, always take screenshots of technical errors or other potential problems, as they may help your case if you need to apply for an SEP, says Donovan.

Another situation that counts: if you applied for Medicaid or the Children’s Health Insurance Program (CHIP) during the annual ACA Open Enrollment Period and found out that you were ineligible after Open Enrollment ended.⁴ (Medicaid and CHIP are types of healthcare coverage offered to people with a low yearly income.)

Of course, the easiest way to know if you qualify for an SEP is to ask, Anderson says.

Don’t qualify for a special enrollment period? Learn how a short term health plan or extended short term health plan could provide temporary coverage. Browse plans online.

2. How can I enroll in an ACA Marketplace health insurance plan after a qualifying life event?

It can’t hurt to be prepared with documents proving your life event — your marriage license, for example, or your child’s adoption certificate. If you don’t have them right away (or you’re not sure what you need), that’s all right, Anderson says. The licensed insurance agent you connect with can help you find out what documents you need.

Just make sure you submit those documents within 30 days of applying for coverage or your plan selection may be canceled. In some cases, you may not need any documentation. You’ll just need to attest that the information is true, with no evidence required.⁵

It’s good to remember when your coverage starts, Donovan says. It may not take effect right away, so anticipate potential gaps in coverage, or try not to let your coverage lapse.

If you enroll in coverage via the marriage SEP, coverage starts on the first day of the following month. For a new baby or adopted child, coverage usually takes effect retroactively, going back to the date of birth or adoption.²

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3. Are there any exceptions to special enrollment rules?

Yes. In many cases, you can change health plans, but you may not be able to go from being uninsured to insured right away.

Also, if you already have Marketplace coverage, don’t expect to change to whatever plan you want.

In fact, you may not be able to change plans at all: If you get married, you can add your new spouse to your current plan, or they can enroll in a separate one. But you can’t change plans. If you had a baby or adopted a child, you can add your new dependent (child) to your plan — but again, you can’t change plans (unless the plan you’re on doesn’t cover dependents).⁶

If you can change plans, chances are you’ll have to choose from certain metal categories (that’s how the different ACA Marketplace plans are presented: bronze, silver, gold and platinum). In fact, the most common SEPs — loss of health insurance, moving to a new area and a change in household size — allow you to pick a plan only from your current category.

A few instances when you can change categories:

• You become newly eligible for cost-sharing reductions. These are special savings on deductibles (the amount you have to pay for health services before your health insurance kicks in), as well as copays and coinsurance (payments made after your deductible is met) that you have to be in a silver plan to take advantage of.
• Your household size changes — due to marriage, birth or adoption — and no other plans in your current category allow you to add new members. (In that case, you can enroll together in a category that’s one level up or one level down.)
• You enrolled in the wrong plan due to misrepresentation or plan display error.

4. What are the options if I don’t qualify for an SEP?

If you’re between annual ACA Open Enrollment Periods and don’t qualify for an SEP, you may still have options. You can apply for Medicaid and CHIP year-round, if you qualify.

Another option is short term health insurance.* It’s a type of health insurance that offers coverage for a limited time, typically for several months to a year. It can be a decent option for those who are relatively healthy and just need something to help them get by for a few months, says Anderson.

Just be sure you do your homework: Many short term health plans have significant exclusions, such as pregnancy or labor delivery coverage, mental health services and certain medications, which may not be immediately obvious. “Be very clear as to exactly what is covered,” Anderson says.

Plus, short term health plans are generally subject to medical underwriting. If you have a preexisting condition, a short term plan won’t cover expenses related to that condition, and you may not be able to qualify for coverage in the first place.

“Most of these plans are designed for people who are relatively healthy, with a low probability of using many services,” Anderson says. Even if that’s you, you don’t want to rely on it as a long-term solution.

With a Marketplace plan, your premium won’t go up because of your health status, Anderson says.

Depending on which state you live in, you might also consider extended short term health insurance — a “short term” insurance that can last for nearly three years. It's important to note that on these plans:

• Some pre-existing conditions may be covered after the first year.
• These plans are medically underwritten.
• The premium increases after the first year. Premium rates are estimated and subject to change based on underwriting results and health status.
• Preventive care has a 6-month waiting period.

SEPs can seem complicated, but they exist to make sure a big life change doesn’t leave you without health coverage. If you’re not sure whether you qualify, a licensed insurance agent can help you find out.