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Many changes can happen throughout our lives that impact our family in a variety of ways; for example, the arrival of a new child, changing jobs, a divorce, death, or move.

All of these affect the dynamics of your health insurance. This is why the Patient Protection and Affordable Care Act (ACA, also known as Obamacare), establishes a Special Enrollment Period outside the yearly window. This gives you the peace of mind of knowing that you and your family will have healthcare coverage and receive the medical attention you need when experiencing an extraordinary life event.

One of these special situations, known as a “qualifying life event,” is moving. This applies whether you have a plan through the insurance marketplace and your new address is outside their service area, or you start a new stage of life elsewhere and want to purchase insurance.

• Marketplace Insurance in Your State

The following guide explains what this special enrollment period is and outlines the specific situations in which you can apply to add, remove or modify your health insurance outside the annual enrollment period. Section 2.2 outlines the qualifying events related to a change in residency.

1. What is a Special Enrollment Period?

Since 2010, when the  Affordable Care Act went into effect, people who don’t have insurance through their employer (or who are over 65 and on Medicare) can register annually in the health insurance marketplace in their state to obtain medical coverage, and even find out if they qualify for Medicaid.

In order to make it easier to apply, each year there is a period known as an Open Enrollment Period, which in most states runs from November 1 through December 15. In some states, however, the period is longer, for example, in California. 

This is not only a time for new consumers to register in the marketplace to purchase a plan, but it is also a good time for individuals who already have a plan to change it for one that is more attractive or has more benefits.

During the enrollment period you can also find out if you are eligible for financial aid (tax credits and refunds) that can help cover the cost of coverage if you don’t have the resources to do so.

Outside of the yearly Open Enrollment Period , no one is able to enroll in the ACA marketplaces to purchase health care plans unless they are experiencing a “qualifying life event.” People whose situations qualify can apply for coverage in what is known as a Special Enrollment Period or SEP.

It’s very important to know what circumstances allow you to apply for coverage during a SEP so you can obtain coverage  outside of the official yearly enrollment period.

2. Life Events that Make you Eligible for a Special Enrollment Period

There are several types of events that qualify you for an SEP. They are divided into five main categories: changes in the composition of the household or nuclear family, changes in residency, loss of medical coverage, other situations, and complex cases.

2.1. Household Composition Changes

This SEP is for people whose families have gone through recent changes, meaning there are more or less members in the family.

In all cases you have 60 days to request the special period.

- You got married. If you were married in the last two months, you can choose to obtain new coverage during a Special Enrollment Period. You just have to choose a termination date for your previous plan, and a new one that covers your spouse will start the next day.

- You got divorced or legally separated. If you recently legally dissolved your marriage, whether through a divorce or separation, and have lost your insurance, you are eligible for an SEP. However, it’s important to remember that if you haven’t lost coverage then you are not eligible for a special enrollment period simply because you got divorced or separated.

- A new child, whether through birth, adoption or temporary custody. In all of these cases you can obtain coverage starting from the day the child arrives, and up to two months after.

- Death. If anyone covered by your health insurance plan passes away, and that leads to changes in your plan, you are eligible for a SEP that will allow you to obtain new coverage which takes this change into consideration.

If you aren’t sure if any of these situations relating to changes in household composition apply to you, our SEP qualifying events calculator can help .

2.2. Change in residency or primary place of living.

If your address or residency has changed recently, you are also eligible for a Special Enrollment Period that will allow you to obtain new coverage. It’s important to keep in mind that moving in order to receive medical treatment or go on vacation does not make you eligible for an SEP. As such, the only justifiable changes in residency are the following:

- Arrival to the United States. If you arrive for the first time or return after residing abroad, you have the right to acquire coverage upon your arrival.

- Moving. Moving to a new country, state or an area with a different zip code.

- Moving to attend school. If a student changes residency to study, they are eligible for an SEP to purchase student coverage.

- Temporary work. If, as an employee, you are required to change your residency temporarily due to work, you can qualify for an SEP.

- Moving to or from a shelter or temporary housing. If you are living in a temporary shelter or transitional housing and you move to another similar situation, you also qualify.

If you aren’t sure if any of these situations relating to changes in primary place of living apply to you, our SEP qualifying events calculator can help.

2.3. Loss of medical coverage

If you have lost health coverage, you have up to 60 days to request a Special Enrollment Period and purchase a new policy. This also applies if you think that a member of your family may lose coverage in the next 60 days.

You may lose medical coverage for various reasons, but only some make you eligible. They are:

- Loss of coverage provided by an employer. If your employer withdraws coverage, or if a family member has had this happen, you are eligible for a Special Enrollment Period. This includes loss of coverage because you are no longer a dependent of your parents or guardians and you are excluded from their plan. In this case, it is important to note that if a dependent voluntarily excludes themselves from their parents’ or guardians’ coverage, they are not eligible for the special enrollment period. The same applies if coverage is lost due to non-payment of premiums, regardless of whether it is you or a family member that fails to pay.

- Loss of coverage due to changes in plan conditions. If there is a change in the eligibility conditions for your insurance, you can lose coverage. When this occurs, in some cases you can qualify for another insurance plan through an SEP. In order to be eligible, the following conditions must apply:
* Your plan no longer exists or is discontinued or eliminated by the insurance company.
* You are no longer eligible for a student health care plan because you are no longer a student or graduated.
* Your year of individual medical coverage ends mid-year and you do not wish to renew it.
* You are no longer eligible for a plan because you no longer live in the service area for said insurance plan.
In these cases, it’s important to remember that if you voluntarily cancel your plan, then you are not eligible for a Special Enrollment Period. This also applies if you have lost your coverage for non-payment of premiums or for having failed to provide the documentation required by your insurance company at any time.

- Loss of coverage due to ineligibility for Medicaid or CHIP. If you are no longer eligible for coverage through Medicaid or the Children's Health Insurance Program (CHIP), which can occur for the following reasons:
*Your income has changed and is now above the range which makes you eligible for Medicaid.
*You are over the age of 26, which makes you no longer eligible for coverage on your parents’ health insurance.

-Loss of coverage obtained through a family member. If you have medical insurance through your parents, spouse, or another person in your family unit and you lose coverage, you may qualify for an SEP in the following circumstances:
* If you are no longer a dependent of your parents or legal guardians.
* If the coverage you had was through a family member who passed away, meaning the plan was extinguished.
* If you turn 26 (or the maximum age for dependents), meaning you are no longer eligible for coverage on your parents’ medical plan.
* If you had coverage associated with your spouse and you divorce or legally separated.
It is a good idea to remember that if a dependent decides to voluntarily abandon the coverage they have through their parents or other family members, then they are not eligible for a Special Enrollment Period.

If you aren’t sure if any of these situations relating to loss of medical coverage apply to you, our SEP qualifying events calculator can help.

2.4. Other situations that make you eligible for a SEP

We have outlined several situations considered as special that allow you access to a Special Enrollment Period. Additional specific events are:

- Becoming a citizen. If you obtain US citizenship, you immediately have the right to request an insurance policy that gives you medical coverage. You have two months to do so.

- Ineligibility for Medicaid or CHIP. Any change in your situation that makes you no longer eligible for Medicaid or CHIP makes you eligible to access new coverage through an SEP.

- You are released from jail. If you have been in prison and are released, you can claim your right to obtain medical coverage during the 60 days subsequent to your release.

- You are a member of a Native American tribe. If you belong to a tribe recognized by the government, or if you are a native of Alaska, you can obtain medical coverage at any time through a Special Enrollment Period.

- You are a member of AmeriCorps, VISTA or NCCC. If you belong to AmeriCorps and are beginning or concluding your service, you can acquire coverage through an SEP.

If you aren’t sure if your situation makes you eligible for a Special Enrollment Period, our SEP qualifying events calculator can help.

2.5. Complex Cases

In addition to all of the aforementioned situations, there are other more complex and dynamic cases. These include processing errors, cases of domestic violence, and other truly exceptional circumstances. They are:

- Errors in the enrollment process. Enrollment errors in a health plan during the regular enrollment period are somewhat frequent. These mistakes can be our own fault, or due to an agent or official in charge of helping you with the enrollment being misinformed or doing their job poorly. This can cause you to not be able to enroll in a plan, enroll in the wrong plan, or cause you not to receive a tax credit discount or cost sharing you may be eligible for. Occasionally, technical errors can occur with the healthcare.gov website when enrolling. These errors can cause you to not be enrolled in a plan or result in your insurance company not correctly receiving your enrollment application. The system may also reject your application due to an issue with your immigration status. Lastly, the website might show incorrect plan data at the time you are enrolling, resulting in an erroneous application.

- Enrollment with misinformation or processing errors. If there is an error in submitting your application, you can request that it be reprocessed during a special period. One reason for this would be, for example, finding out that you qualify for a reduced premium that was not processed. Another common situation is finding out that the insurance company offered coverage and benefits that they did not provide; for example, it stated that a doctor was in its network of providers when in reality they were not.

- Appeal decided in your favor. If your application was rejected during the open enrollment period, or if you received an incorrect start date for coverage, you have the right to submit a claim. If they find your claim admissible, you can request that an SEP be opened for you.

- Ineligibility for Medicaid or CHIP. If you are told that you are ineligible for Medicaid or CHIP during the open enrollment period, you can reapply during a Special Enrollment Period regardless of if the application was submitted through the marketplace or directly through your state’s Medicaid or CHIP office.

- Exceptional natural circumstances. If during the open enrollment period you were unable to submit your application due to causes of force majeure caused by a natural disaster or because you were suffering from a serious illness, you can request an SEP. This applies to natural tragedies, such as hurricanes or earthquakes, making victims eligible for a SEP. It also includes the loss of a family member, or moving from the place affected by the disaster.

As you can see, there are many events in which you can request a Special Enrollment Period to purchase medical coverage through an insurance company. In addition, remember that you can always submit a claim to appeal a decision if your request to open an SEP is rejected. If you eventually earn the right to qualify, the insurance company is required to provide coverage that will protect you retroactively: the start date will be the same as that on which your request for a Special Enrollment Period was denied.

If after reading this article you aren’t sure if you qualify for a Special Enrollment Period, you can use our handy verification tool to see if you qualify to register in the marketplace outside the yearly enrollment period.