There are a handful of special circumstances and life events that could qualify you for a Special Enrollment Period, also known as “SEP.” These life changes can trigger a Special Enrollment Period that begins 60 days before the qualifying life event and lasts 60 days after the qualifying life event. The most common “life events” are listed below.
- You or a dependent lose job-based coverage
- You or a dependent terminate your Medicaid coverage
- You get married, have a baby, adopt a child, or placed a child for foster care
- You gain US citizenship
- Your income changes significantly, making you newly eligible (or ineligible) for subsidies
- You permanently move to a new zip code (and were previously enrolled in health coverage) or from outside of the country
- You are or gain status as a Native American Indian
The reason for this stems from the Affordable Care Act, which mandated that health insurance companies can no longer deny individuals coverage for preexisting conditions. In other words, individuals are guaranteed coverage regardless of their health status.
If individuals could simply start and stop coverage whenever they wanted, many people would simply wait until they got sick or required expensive medical care before buying insurance. That is why the government has limited the time to purchase health insurance to the annual Open Enrollment Period, which typically runs from November 1st of each year through December 15th for coverage starting the first of the following year.