In general, when open enrollment ends, you can't apply for health insurance until the next year. However, special enrollment lets you apply for health insurance during other times of the year if you have specific major life changes.
What is the difference between open enrollment and special enrollment?
Open enrollment is the period of time when you can buy new health insurance or change your current insurance. During open enrollment, you can apply for insurance and, because of the Affordable Care Act, in most cases insurance companies must accept your application.
- Open enrollment for 2018 begins November 1, 2017 and, in Washington State, ends January 15, 2018.
- If you get insurance through your employer, the open enrollment dates are specific to your employer.
During times outside the yearly open enrollment dates, you can apply for insurance or make changes to your existing insurance only if you have a major life change, such as the loss of a job or the birth of a child (other changes may also qualify). This is called special enrollment. You have 60 days from the life change event to apply.
How do I qualify for special enrollment?
The list below includes the life changes that would qualify you for special enrollment. Remember, you can only apply for special enrollment for up to 60 days after the event occurs.
- Getting married and adding a dependent to your current policy
- Having a baby or adopting a child
- Permanently moving to a new ZIP code or county where your health plan does not provide coverage
- Losing health coverage
You may also qualify for special enrollment if you lose your health insurance because:
- You lose your job
- Your work hours are reduced
- You get divorced or legally separated
- You lose coverage due to your spouse qualifying for Medicare
- The person you are covered under dies
- You get too old to be covered under your parents' plan (turning 26 years old)
- You lose eligibility for Medicaid or CHIP
- Your employer goes bankrupt under Chapter 11
Washington state law also considers the following events when you apply for special enrollment:
- You lose eligibility for a public health benefits program
- You end a domestic partnership
- You lose your COBRA coverage
- You lose your enrollment from the Washington State Health Insurance Pool (WSHIP)
For a complete list of changes that qualify for special enrollment, go to healthcare.gov.
There may also be other conditions that qualify you for special enrollment.
Is there a deadline for special enrollment?
You can only apply for special enrollment for up to 60 days after the major life change event occurs.
If you want your coverage to start on the first day of the next month, your application must be received online or by US postal mail by the 15th of the month. For example, if you apply by February 15, coverage starts March 1. If you apply after February 15, coverage starts April 1.
When will I not qualify for special enrollment?
If you choose to end your own insurance coverage, you won't qualify for special enrollment; you'll have to wait until open enrollment to get new insurance. Also, you may not qualify for special enrollment if your prior insurance did not meet the minimum essential coverage standards.