Open Enrolment runs November 1 to January 15. Outside that window the Marketplace is closed unless something specific happens in your life. The list of things that count is shorter than people expect, and the deadline is stricter.
The clock starts at the event
You have 60 days from the qualifying event. Not 60 days from when the letter arrived, not 60 days from when you realised, not 60 days from when the old plan stopped paying claims. From the event.
For most events you can also apply in the 60 days before a planned loss of coverage. If you know your job ends on the last day of March, applying in February means no gap at all. That is always the better move, and it is the one people most often miss.
What counts
- Loss of coverage: a job ending, an employer plan terminating, ageing off a parent's plan at 26, or COBRA running out. Voluntarily dropping a plan you could have kept does not count.
- A permanent move to a new county or ZIP code that changes the plans available to you, if you had coverage for at least one of the previous 60 days.
- Marriage, where at least one spouse generally had coverage in the previous 60 days.
- Birth, adoption or placement for foster care. Coverage can usually be backdated to the date of the event.
- A change in income that makes you newly eligible or newly ineligible for a premium tax credit or for cost-sharing reductions.
- Gaining lawful immigration status or citizenship.
- Release from incarceration.
- A carrier or Marketplace error, or a substantial plan contract violation.
What does not count
Getting sick does not open a window. Getting a large medical bill does not open a window. Deciding you should have bought coverage in November does not open a window. Neither does a plan getting more expensive at renewal, which surprises people every January.
We say this plainly because the alternative is letting someone hope for two weeks before telling them.
Bring the paperwork on the first call
The Marketplace verifies most Special Enrolment Periods, and it will suspend coverage if documents do not arrive in time. Having them on the first call is usually the difference between coverage starting on the first of next month and coverage starting two months late.
- Loss of coverage: a termination letter or a letter of creditable coverage that states the end date
- Move: a lease, deed, utility bill or USPS confirmation showing the date and the new address
- Marriage: the certificate
- Birth or adoption: the birth certificate, hospital record or placement papers
- Income change: pay records, a new contract, or an updated projection with your CPA's letterhead where you have one
What to do on day one
Call us the day the thing happens, not the day the coverage stops. Half the Special Enrolment Periods we run could have been started before the gap existed, and a retroactive fix is always more work than a planned one.
If you are already past day 40 with no documents, say so. There are still options, and the earlier we know how much runway is left the better they are.
An estimate for planning, not a quote. HealthCare.gov sets your real credit.
