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Health Insurance

Special Enrollment Periods: Life Events That Let You Sign Up Midyear

Which life events open a special enrollment period, how long you have to act, when coverage starts, what documents you may need, and the rules for employer plans.

By All Blog Article Editorial Team · Published · 9 min read

A special enrollment period is a window outside open enrollment when you can buy or change a health plan because of a qualifying life event, such as losing other coverage, getting married, having a baby or moving. For a Marketplace plan you usually have 60 days from the event to pick a plan, or 90 days if you lost Medicaid or the Children's Health Insurance Program (CHIP).

On HealthCare.gov, open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027. From January 16 to October 31, 2027, a special enrollment period is generally the only way to get or change a Marketplace plan. Employer plans have their own version of the rule, with deadlines that are generally shorter. This guide covers both.

Key takeaways

  • Most Marketplace special enrollment periods last 60 days from the event. Losing Medicaid or CHIP gives you 90 days.
  • On HealthCare.gov, if you know your coverage will end, you can report it up to 60 days in advance and have a new plan start on the first day of the month after the old one ends.
  • Coverage usually starts on the first day of the month after you pick a plan. On HealthCare.gov, a birth, adoption or foster placement is covered back to the date of the event.
  • Dropping coverage on your own, including COBRA, or losing it for not paying premiums does not usually qualify.
  • Employer plans must give you at least 30 days after losing other coverage, marrying, or gaining a child, and at least 60 days after losing Medicaid or CHIP.

Life events that open a Marketplace special enrollment period

Many events turn on losing qualifying coverage, also called minimum essential coverage. It includes job-based plans, individual plans, COBRA, most Medicaid and CHIP coverage, and Medicare Part A or a Medicare Advantage plan. Short-term limited-duration insurance does not count.

Losing coverage

  • Losing job-based coverage, whether through your own job, a spouse's job or a parent's plan, for example when you leave a job or age out of a parent's plan.
  • Losing an individual plan, Medicaid or CHIP, or premium-free Medicare Part A.
  • COBRA ending because it reached its maximum length, usually 18 to 36 months, or because your former employer stopped paying its share of the premium.

Household changes

  • Getting married. At least one spouse must have had qualifying coverage for at least one day in the 60 days before the wedding. Exceptions include a spouse who lived abroad or in a U.S. territory during that time, or who is a member of a federally recognized tribe.
  • Having a baby, adopting a child, placing a child in foster care, or gaining a dependent through a child support or other court order.
  • Divorce or legal separation, but only if it causes you to lose coverage.
  • The death of someone on your Marketplace plan, if it causes you to lose your current plan.

Moving

A permanent move to a new ZIP code or county where different Marketplace plans are sold qualifies, as does moving to the U.S. from abroad or a U.S. territory, a student moving to or from school, a seasonal worker moving for work, or moving to or from a shelter. You generally must have had qualifying coverage for at least one day in the 60 days before the move, unless, for example, you were living abroad or in a U.S. territory during that time. Moving only for medical treatment, or staying somewhere on vacation, does not qualify. The rules are explained further in what happens to your health insurance when you move.

Status, eligibility and other events

  • Becoming a U.S. citizen, national or lawfully present, or leaving incarceration. Switching from one lawful immigration status to another does not count.
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act corporation shareholder. Members can change plans once a month.
  • Starting or ending AmeriCorps State and National, VISTA or NCCC service.
  • Becoming newly eligible or ineligible for savings while enrolled, for example after an income change.
  • Being offered an employer account that pays toward an individual plan, such as an individual coverage HRA or a QSEHRA. HealthCare.gov says this enrollment must be finished by phone with the Marketplace Call Center.
  • Enrollment errors, misinformation from an insurer, agent or assister, or wrong plan details shown on HealthCare.gov.
  • Exceptional circumstances such as a natural disaster or an unexpected hospitalization that kept you from enrolling, and surviving domestic abuse or spousal abandonment.

What does not qualify

  • Ending coverage on your own. Voluntarily dropping a plan, including cancelling COBRA early or simply stopping COBRA payments, does not open a window. Leaving a job voluntarily is different: if it ends your job-based coverage, that loss still counts.
  • Not paying premiums. Losing coverage for non-payment does not qualify, unless it was your employer that stopped paying for a job-based plan.
  • Missing the window. If you lost coverage more than 60 days ago, or more than 90 days ago for Medicaid or CHIP, you generally wait for open enrollment.

The low-income monthly window

Until August 25, 2025, people on HealthCare.gov who qualified for premium tax credits and expected income at or below 150% of the federal poverty level could enroll or change plans once a month. CMS, the federal agency that runs HealthCare.gov, ended that option for all exchanges on August 25, 2025, under its 2025 rule. CMS's 2027 payment rule, finalized in May 2026, keeps exchanges barred from offering it after 2026. A CMS training deck for enrollment assisters, dated September 2026, says instead that it returns for 2027, so CMS's own materials conflict. Either way, a federal law signed in July 2025, Public Law 119-21, disallows the premium tax credit for coverage chosen through a special enrollment period that is based on low expected income alone. That rule applies to plan years beginning after December 31, 2025. So a low income by itself no longer opens a way into subsidized coverage midyear.

How long you have, and when coverage starts

EventTime to pick a planCoverage usually starts
Losing coverage, reported in advanceUp to 60 days before it endsFirst day of the month after the old coverage ends
Losing coverage, reported afterward60 days after it ends (90 for Medicaid or CHIP)First day of the month after you pick a plan
Birth, adoption, foster placement or court order60 days after the eventThe date of the event (for a court order, its effective date). You can call to ask for the first of the month after you pick a plan instead
Marriage60 days after the weddingFirst day of the month after you pick a plan
Permanent move60 days after the moveFirst day of the month after you pick a plan

For a loss of coverage, the qualifying event is the last day of your old coverage, not the day you left your job. Since January 1, 2025, state-run exchanges must also start most special enrollment coverage on the first day of the month after you pick a plan, so a late-month choice still takes effect the next month.

If you already have a Marketplace plan and use a special enrollment period to switch, you are generally limited to a plan in the same metal category, such as bronze to bronze, until the next open enrollment. Exceptions include becoming newly eligible for cost-sharing reductions, which come only with silver plans.

Example: The person and dates are illustrative; the 60-day rules are the federal ones that apply in 2027. Maria is leaving her job, and her job-based coverage ends on March 31, 2027. She can report the loss and pick a Marketplace plan up to 60 days before that date. If she picks a plan on March 20, her new coverage starts April 1, 2027, with no gap. If she waits until April 20, coverage starts May 1, 2027, leaving April uncovered. Her window closes 60 days after March 31, on May 30, 2027. If she instead elects COBRA and cancels it on her own after May 30, that cancellation does not open a new window; she would wait for open enrollment unless another life event occurs. The trade-offs are covered in COBRA vs a Marketplace plan.

Documents you may be asked for

When you apply through a special enrollment period, the Marketplace may ask you to prove the event. Your eligibility notice will say if it needs documents. On HealthCare.gov you then have 30 days after picking a plan to send them, and you cannot use the coverage until your eligibility is confirmed and you pay the first premium.

For a loss of coverage, acceptable proof includes a letter from your former insurer or employer, a COBRA letter showing when COBRA ended, or a letter from a program such as Medicaid, Medicare or TRICARE. It must show your name and the date coverage ended. If you have none of these, you can send a letter of explanation instead.

For 2026, HealthCare.gov checks documents before enrollment only for loss-of-coverage special enrollment periods. CMS's 2027 payment rule would have required checks on at least 75% of new special enrollments on HealthCare.gov, but a federal court stayed that requirement on July 16, 2026, while the case continues. CMS says the stay does not affect the existing loss-of-coverage checks. State-run exchanges set their own verification rules.

Special enrollment in employer plans

Job-based plans follow a separate federal rule, often called HIPAA special enrollment. The plan must let eligible employees and their family members enroll midyear after these events:

  • Losing other coverage, or an employer ending its contribution to that coverage: at least 30 days to ask.
  • Gaining a dependent through marriage, birth, adoption or placement for adoption: at least 30 days.
  • Losing Medicaid or CHIP, or becoming eligible for state help paying the premium: at least 60 days.

Plans may allow longer, so check your plan documents. For a birth, adoption or placement for adoption, coverage must start no later than the date of the event. For a marriage or loss of coverage, it must start no later than the first day of the month after the plan receives your request. Moving is not on this list, so a move usually affects an employer plan only if it ends that coverage. For newborns, the steps for both kinds of plan are in how to add a newborn to your health insurance.

Frequently asked questions

Can you report a loss of coverage before it happens?

Yes. On HealthCare.gov you can report it up to 60 days before your coverage ends. If you pick a plan before then, your new coverage starts the first day of the month after your old coverage ends, which avoids a gap.

Does quitting your job count as a qualifying event?

Yes, if leaving ends your job-based coverage. The event date is the last day of that coverage. What does not count is dropping coverage you could have kept, such as cancelling COBRA early.

What if you miss the 60-day deadline?

You generally have to wait for open enrollment, which for 2027 coverage on HealthCare.gov runs November 1, 2026 to January 15, 2027; see the 2027 open enrollment dates and checklist. Medicaid and CHIP accept applications any time of year, so check whether you qualify for those.

Does a new baby's coverage start on the birth date?

It can. On HealthCare.gov, coverage for a birth, adoption or foster placement is back-dated to the date of the event, and you have 60 days to enroll. If you prefer, you can call the Marketplace Call Center and ask for coverage to start on the first of the month after you pick a plan. Employer plans must also cover a newborn from the date of birth if you enroll within the plan's deadline, which is at least 30 days.

Do you need to send documents for every life event?

Not always. Your eligibility notice says whether documents are needed. On HealthCare.gov the main pre-enrollment check is for loss of coverage, and you have 30 days after choosing a plan to send proof.

Sources

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