At a glance
- Marketplace plans have one yearly sign-up window, called Open Enrollment. HealthCare.gov publishes the current dates.
- Outside that window, a qualifying life event such as losing coverage, moving, marriage or a new child can open a Special Enrollment Period, usually lasting 60 days.
- Medicaid and CHIP have no window: you can apply any day of the year.
- Job-based plans and Medicare run on their own calendars, separate from the Marketplace.
Why sign-up windows exist
Most people in the United States cannot buy or change a private health plan on any day they choose. Plans sold through the Health Insurance Marketplace, and most job-based plans, accept new members only during set periods. The idea is that people sign up before they need care rather than waiting until they are ill, which keeps coverage workable for everyone in the plan.
That makes timing one of the first things to understand. Whatever your situation, the question "can I sign up now?" usually has one of three answers: yes, because it is Open Enrollment; yes, because something in your life changed recently and opened a Special Enrollment Period; or yes, because the program you are applying for has no window at all. This pathway explains each answer, and the other pathways on this site point back here when a deadline matters.
A note on words. The "Marketplace" (sometimes called the exchange) is the official place to compare and buy individual health plans, with help paying for them if you qualify. HealthCare.gov runs it for most states. Some states run their own Marketplace with its own website, and HealthCare.gov directs residents of those states to it.
Open Enrollment
Open Enrollment is the yearly period when anyone eligible can sign up for a Marketplace plan, change plans, or drop one, without needing a reason. According to HealthCare.gov, it runs once a year, starting in the autumn, and the plan you choose covers the following calendar year. When you enroll within the window affects when coverage starts, so enrolling early in the window usually means coverage begins with the new year.
This site does not list the exact dates, because they can change from year to year and some states with their own Marketplace set different, sometimes longer, deadlines. The official dates for the coming year are on the HealthCare.gov page called "When can you get health insurance?", and a state-run Marketplace publishes its own.
Open Enrollment is also when people already enrolled can review their plan. Plans change their costs, covered drugs and networks from year to year, and the financial help you qualify for depends on your expected income for the coming year. If you do nothing, many Marketplace enrollees are renewed automatically, but an automatic renewal may not be the best match for a new year's circumstances.
Special Enrollment Periods
A Special Enrollment Period, often shortened to SEP, is a chance to enroll in or change a Marketplace plan outside Open Enrollment because of a qualifying life event. HealthCare.gov groups the common qualifying events into a few families:
- Losing health coverage. For example, losing job-based coverage, aging off a parent's plan at 26, losing Medicaid or CHIP eligibility, or a COBRA period running out.
- Changes in household. Getting married, having a baby or adopting a child, or a death in the family that affects coverage.
- Changes in residence. Moving to a new home in a different area, for example a new ZIP code or county, or moving to the United States. A move usually counts only if you had qualifying coverage for at least one day in the 60 days before the move, with some exceptions.
- Other changes. HealthCare.gov lists further situations, such as changes in income that affect eligibility for financial help, becoming a US citizen, or leaving incarceration.
In most cases the Special Enrollment Period lasts 60 days from the event. For a loss of coverage that you know is coming, HealthCare.gov explains that you can often report it and pick a plan up to 60 days before the coverage ends, which can help avoid a gap. The Marketplace may ask for documents that confirm the event, such as a letter showing the date your old coverage ended.
Worked example (invented)
A person moves to a new county in late spring after having job-based coverage for the past year. Because the move is a qualifying event and they had coverage before it, the Marketplace may offer a Special Enrollment Period. They have about 60 days from the move to choose a plan, and they keep the letter showing their new address in case the Marketplace asks for proof. This example describes no real person.
What usually does not count
Some events feel like they ought to open a sign-up window but generally do not. HealthCare.gov explains that losing coverage because you stopped paying premiums, or because you chose to drop a plan, is not a qualifying event. The same applies to dropping COBRA continuation coverage early outside Open Enrollment: choosing to end it does not by itself open a Special Enrollment Period, while COBRA running out at the end of its term does. If you are weighing a change, it is worth checking with the Marketplace before you end any existing coverage.
Getting a new diagnosis or needing treatment is also not a qualifying event on its own. That is the main reason the windows exist.
Coverage with no window
Medicaid and the Children's Health Insurance Program (CHIP) do not have an enrollment period. HealthCare.gov states that you can apply for them any time of year, and if you qualify, coverage can begin right away. You can apply through your state Medicaid agency or by filling out a Marketplace application, which checks whether anyone in the household looks eligible for Medicaid or CHIP and passes the information to the state.
Changes in income can also matter in the other direction. If your income falls and you become eligible for Medicaid, the Marketplace application is one way to find out. The Medicaid and CHIP pathway explains how the programs work.
Job-based plans and Medicare
Two other kinds of coverage keep their own calendars, separate from the Marketplace.
Job-based plans. An employer's plan usually has its own yearly enrollment period set by the employer, plus a chance to join when you first become eligible as a new hire. Federal law also gives special enrollment rights in group health plans. The US Department of Labor explains that if you lose other coverage, or gain a dependent through marriage, birth or adoption, the plan must let you enroll if you ask within at least 30 days. Plans can allow longer, so the plan's own rules are the place to check.
Medicare. Medicare has an Initial Enrollment Period around your 65th birthday, a yearly General Enrollment Period for people who missed their first chance, a yearly autumn period for changing Medicare Advantage and drug plans, and Special Enrollment Periods for situations such as stopping work. Medicare.gov publishes the details. The turning 65 pathway walks through them.
| Coverage | Main window | Outside the main window |
|---|---|---|
| Marketplace plan | Yearly Open Enrollment | Special Enrollment Period after a qualifying event, usually 60 days |
| Medicaid and CHIP | None: apply any time | Not needed |
| Job-based plan | When first eligible, and the employer's yearly period | Special enrollment rights of at least 30 days after certain events |
| Medicare | Initial Enrollment Period around age 65 | General Enrollment Period, or a Special Enrollment Period in some situations |
Questions to take to official help
This site cannot tell you whether you qualify for a Special Enrollment Period. The Marketplace decides that when you apply. Before you contact HealthCare.gov or a Marketplace Navigator, it can help to have answers ready to these questions:
Have these answers ready
- What changed, and on what date? Do you have a letter or document that shows it?
- What coverage did you have before the change, and when did it end or when will it end?
- Which state and county do you live in now?
- Who is in your household for tax purposes, and roughly what do you expect your household income to be this year?
Navigators are trained helpers for Marketplace, Medicaid and CHIP applications. HealthCare.gov describes their services as free and says they are required to be unbiased, and it lists the ones near you. That makes them different from agents and brokers, who are licensed to sell plans.
Next pathway: I lost my job: keeping or replacing your health coverage