How Can I Get Health Coverage Outside the Annual Open Enrollment?

Researcher & Writer
January 18, 2016

There are options if you need to apply for medical coverage outside the open enrollment period. Medicaid and Children’s Health Insurance Program (CHIP) do not have enrollment periods, so you can apply any time throughout the year. If you qualify, you will be covered immediately.

If you are a member of a government recognized tribe or Alaskan Native shareholder, you can enroll throughout the year. You aren’t limited to the enrollment period. You can also change your plan up to once a month; you are not committed to one plan for the year.

There are also special enrollment periods anyone may qualify for. You can get a special enrollment period if you have gone through a life changing event. A "life changing" event is defined in this case as one recognized by the government as something that may change your eligibility status. Life changing events may involve changing the size of your household or changing your household’s income. You have up to 60 days following the life-changing event to enroll.

The government has created a list of approved life changing events that can be used as the basis for a special enrollment period. They include:

  • Having a baby
  • Adopting a child
  • Having a foster child placed in your home
  • Getting married
  • Losing your health insurance coverage regardless of the reason
  • Moving out of state
  • Becoming a US citizen
  • Being granted membership to a recognized tribe or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • If the primary covered person in your household dies
  • Reentering society after being incarcerated
  • Aging off your parent’s health insurance
  • Americorps VISTA members that are coming out of their service period
  • If you have a change to your income, that will impact your eligibility.

If you have experienced one of the approved life changing events, you can request a special enrollment period. If you have experienced an event that has altered your eligibility but is not specifically listed, you can still apply for a special enrollment period. If it is not on the list, your application may be denied. However, if your life changing event does alter your eligibility, you would have a solid argument supporting your request.

You can also apply for a special enrollment period based on extreme and unexpected circumstances. For example, if you experienced a serious medical issue, which involved unexpected hospitalization or a cognitive disability, you can apply for a special enrollment period. Additionally, if your household experiences an earthquake, hurricane, or another natural disaster, you can request a special enrollment period.

To apply for a special enrollment period, you can contact the Marketplace call center at 1-800-318-2596. If your application for special enrollment is denied, you can appeal the denial. You can get an appeal form on the healthcare.gov website. Once you print and fill out the form, it can be mailed to:

Health Insurance Marketplace

Attn: Appeals

465 Industrial Blvd.

London, KY 40750

Written by
Eligibility Team
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