Special Enrollment Periods

Each year there is an annual enrollment period for all individual health insurance enrollment. For 2015,  it will be November 15, 2015 to February 15, 2015. This applies to any plan you purchase through the Healthcare Marketplace as well as all individual, non group health insurance plans that does not qualify for a subsidy, you purchase as an individual for you and your family.

You can only purchase a qualified individual health plan outside the annual open enrollment period when you experience a Qualifying Life Event (QLE). A QLE is a circumstance, that causes such a big change in your life that you are allowed a special enrollment period to enroll in an ACA health plan (like having/adopting a baby, getting married, loosing other coverage, etc.)

Examples of coverage loss that create a QLE for a special enrollment period under the Affordable Care Act include:


  • Policy or plan year ended for policy you bought yourself – This would be your renewal with your current plan.
  • Loss of minimum essential coverage – non-employer based such as loosing eligibility for Medicaid or CHIP (Children’s Health Insurance Program) or Tricare.  
  • You are offered COBRA by your former employer.*
  • Your COBRA coverage is ending. (18 or 36 months).
  • Are not eligible for a college student health plan,
  • You lose your job and therefore your group health coverage,
  • Your employer terminates their group health plan
  • Your hours are reduced – full time to part time.
  • Your spouse’s employer no longer offers group health coverage to you.
  • You turn 26 and aged off your parent’s health plan.  Starting in 2014, children up to age 26 can stay on their parent’s employer plan even if they have other coverage through an employer, or are married.Some more info:
  • Changes in household size:

    • Such as getting married
    • Birth of a child
    • If when getting a divorce if you are losing minimum essential coverage through your spouse you are eligible.  If you have your own coverage or have no health insurance currently, you are not eligible for an SEP.
    • Adopting a child or having a child placed with you for foster care.
    • The death of the person who was the primary subscriber.

    Changes in circumstance:

    • Moved outside your health plan’s coverage area or out of state.
    • Changes in status: Your income changes so much that you become newly eligible or ineligible for insurance.
    • Gaining citizenship or lawful presence in the U.S.
    • Released from incarceration (prison or detention).
    • Are you a member of a federally recognized tribe, or an Alaska Native corporation shareholder?
      If you have questions. please feel free to call us!