Special Enrollment Period

Know the Difference between Open Enrollment and Special Enrollment Period

Special Enrollment Period is a time when an individual can enroll in a health insurance plan outside the annual Open Enrollment Period.

An individual must experience a qualifying life event and provide proof of eligibility in order to qualify. During the Special Enrollment Period, individuals may enroll in the Affordable Care Act (ACA) health insurance On- or Off- the Virginia's Insurance Marketplace or change from one Qualified Health Plan to another.

Individuals and/or their dependents have 60 days to enroll for health coverage after experiencing a qualifying life event. If you are a Virginian who loses Medicaid coverage, you have 90 days to enroll in a qualified health insurance plan.

Qualifying life events for special enrollment like getting married, having a baby, or losing other health coverage enable you to enroll outside the Open Enrollment Period.

Job-based plans may have different Open Enrollment Periods. Check with your employer.
You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.

Frequently Asked Questions

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How soon can coverage start during a special enrollment period?

New for 2024, most qualifying life events allow you to enroll and begin coverage the firs day of the next month. This works the same as it does during the Open Enrollment Period. For example:

If you enroll on May 10, your coverage starts June 1.
If you enroll on May 17, your coverage starts July 1.

This works the same as it does during the Open Enrollment Period. However, there are a few exceptions which allow same-day effective coverage to begin:

Birth of child
Adoption of child

What qualifies you for a special enrollment period?

Qualifying events for special enrollment are significant changes in your life that enable you to enroll in a health insurance plan outside of the Open Enrollment Period. These qualifying life events may cause you to lose your health coverage or have a change in family status or residency.

Losing Your Health Coverage

Losing coverage because your current health insurance carrier left the service area
Losing job-based coverage for any reason including resigning, getting laid off, or getting fired
Expiring COBRA coverage
Losing coverage under your parent's plan at age 26
Getting divorced or legally separated (resulting in loss of coverage)
Losing eligibility for Medicaid or the Children's Health Insurance Program (CHIP)

Note: Losing coverage that doesn't qualify as minimum essential coverage doesn't qualify you for a Special Enrollment Period. Learn more at HealthCare.gov.

Change in Your Household Size

Getting married
Having a baby
Adopting a child or placing a child for adoption or foster care
Death of family member (causing you to lose eligibility in your current plan)

Change in Circumstance

Permanently moving outside your plan’s coverage area
Gaining or losing income (affecting eligibility for premium tax credits or cost-sharing reductions)

Change in Status

Getting released from jail or prison
Gaining citizenship or lawful presence in the U.S.

For more information on required documentation, please visit HealthCare.gov.

What is a Hardship Exemption?

*A hardship exemption is an exceptional circumstance, and it triggers a 60-day Special Enrollment Period. Examples of exceptional circumstances are unexpected hospitalizations, natural disasters, or temporary cognitive disability. Other hardships may include enrollment errors created by the Virginia's Insurance Marketplace, your broker or by your insurance carrier. For more information, please visit Virginia's Insurance Marketplace.

How Long Does the Special Enrollment Period Last?

A Special Enrollment Period is triggered by a qualifying life event and typically lasts for 60 days. However, the Special Enrollment Period may vary based on the type of qualifying life event.

Qualifying Life Event	Special Enrollment Period (SEP)
Qualifying Life EventGetting Married	Special Enrollment Period (SEP)Up to 60 days after the event.
Qualifying Life EventHaving a baby, adopting or placing a child for adoption	Special Enrollment Period (SEP)Up to 60 days after the event.
Qualifying Life EventLosing your health coverage	Special Enrollment Period (SEP)Up to 60 days before and up to 60 days after the event.
Qualifying Life EventMoving outside your plan's coverage	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventGaining U.S. citizenship	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventChange in income or household status that affects eligibility for premium tax credits or cost-sharing reductions	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventLosing Medicaid coverage	Special Enrollment Period (SEP)Up to 90 days after the event.
Qualifying Life EventRelease from prison or jail	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventHardship Exemption*	Special Enrollment Period (SEP)Up to 60 days after the event.