What Counts as a Qualifying Event?
A Special Enrollment Period opens when something specific changes in your life, not just because you decide you want different coverage. Common qualifying events include:
- Losing job-based or other health coverage
- Turning 26 and aging off a parent's plan
- Marriage or divorce
- Birth, adoption, or placement of a child
- Permanently moving to a new state or service area
- Losing Medicaid or CHIP eligibility
- A change in immigration status that affects eligibility
The 60-Day Clock
You generally have 60 days from the date of the event to enroll. HealthCare.gov also lets you apply up to 60 days before you expect to lose coverage. If you lost Medicaid or CHIP, you may have 90 days. Miss the window, and you typically wait for the next Open Enrollment period unless another qualifying event happens.
A Recent Rule Change Worth Knowing
For several years, households with projected income at or below 150% of the federal poverty level could use a monthly Special Enrollment Period on the federal marketplace. CMS ended that SEP on August 25, 2025, for plan year 2026. In CMS training materials, that pause lasts through plan year 2026, and the SEP is scheduled to return for plan year 2027 (plans starting January 1, 2027). Because this has changed more than once, confirm with us before you rely on an income-only enrollment path.
What You'll Need to Prove It
The marketplace will ask for documentation specific to your event: a coverage termination letter, a marriage certificate, a birth certificate, a lease or utility bill showing a new address, and so on. Having this ready before you start your application speeds things up considerably.