The Affordable Care Act (ACA) has a restricted enrollment period from January 1st until November 1st each year. It is an arbitrary rule for health insurance enrollment, but there is a way to get health insurance outside of this brief period if special conditions apply.

The ACA recognizes the need for plan changes in certain defined circumstances.  These are Qualifying Events, and they allow you to access the ACA health insurance plans throughout the year under the Special Enrollment Period (SEP).

The 4 Types of SEP Qualifying Life Events (QLE)

Loss of health coverage

  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent’s plan

Changes in household

  • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family 

Changes in residence

  • Moving to a different ZIP code or county
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

Other qualifying events

  • Changes in your income that affect the coverage you qualify for
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration (jail or prison)
  • AmeriCorps members starting or ending their service

Changes in residence

There are many things to think about when you move, not least to make sure that your health insurance is valid in your new location.  

Even before you plan a household move, take your healthcare needs into account. First, check that your insurer operates in your proposed new location, is your plan type (and metal level) available, and are the facilities you need within your existing network?  

Fortunately, most location changes open new windows of opportunity to sign up for new plans to match your unique circumstances.

We recommend that you research your needs and local providers (consult your health exchange) before the move, but you have 60 days following your move to enroll in your new health insurance plan.

The following residence changes qualify you for a Special Enrollment Period if you are moving:

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or a United States territory
  • If you are a student, moving to or from the place, you attend school
  • If you are a seasonal worker, moving to or from the place, you both live and work
  • Moving to or from a shelter or other transitional housing

If you are: –

  • A student moving to or from where you attend school
  • A seasonal worker moving to or from the place where you both live and work

Note:

Moving only for medical treatment or staying somewhere on vacation does NOT qualify for a SEP. Prove that you had qualifying health coverage for one or more days during the 60 days before your change in residence.

Photo by Olya Kobruseva from Pexels