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Open and Special Enrollment Periods

Open Enrollment Periods

Under the Affordable Care Act, health insurers selling individual coverage are required to sell a plan to all applicants, with certain limited exceptions. One of the most important exceptions allows insurers to limit the amount of time during the year that policies are available, called an open enrollment period. For coverage that will begin in 2018 and thereafter, open enrollment will be from November 1, 2017 to December 15, 2017 for federally facilitated marketplaces (FFM) or states using HealthCare.gov for enrollment. The annual November 1 to the December 15 timeframe applies to coverage sold on and off the FFM. State-based marketplaces, however, may establish longer open enrollment periods, so check with your marketplace.

If you have any premiums due to your insurer for coverage in the past, your insurer may require that you pay these past-due premiums before enrolling you into coverage during either open enrollment or a special enrollment period, described further below. Beginning June 19, 2017, insurers can take into account past due premiums for coverage in the previous 12 months. This new requirement does not apply if you are signing up for coverage from a different insurer from the one to whom you owe past-due premiums and only affects the person responsible for paying premiums on the previous policy, not other family members enrolled in the plan. If your enrollment is delayed because of past-due premiums and you think this is an error, contact your state’s marketplace and state insurance department; a list of state departments of insurance is available under our Other Resources, Where to Go for Help.

Special Enrollment Periods

Individuals who experience certain qualifying events, such as marriage, moving, or the birth of a child may be eligible for a special enrollment period, which gives them a right to sign up for a plan outside of the open enrollment period. In general, individuals have 60 days from the date of the qualifying event to enroll into coverage. Some individuals will need to verify their eligibility for a special enrollment period by submitting documentation of their qualifying event before they can enroll. This process, referred to as the special enrollment period pre-enrollment verification (SEPV) process, applies to the following qualifying events: loss of minimum essential coverage; permanent move; marriage; gaining or becoming a dependent through adoption, foster care or a court order; and Medicaid/CHIP denials. Individuals will have 30 days to submit the verifying documentation under the SEPV process.

In general, enrollees with existing marketplace coverage eligible for a special enrollment period can only change plans within the same metal level as his or her current plan. However, there are some exceptions to this:

  • This does not apply to those who are newly eligible or ineligible for financial assistance; these enrollees can change into a silver level plan.
  • If there are no other plans within the same metal level, enrollees can enroll in an adjacent metal level plan.
  • For enrollees that gain a dependent or get married, enrollees can add the dependent or spouse to their current marketplace plan or the dependent can enroll in a separate marketplace plan.

Plan selection limitations do not apply to American Indians or Alaska Natives and to the following qualifying events: marketplace or marketplace-related error or misconduct, exceptional circumstances, and domestic violence. For more information, go to Resources, More Tools for Consumers.

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