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 2024, open enrollment will be from November 1, 2023 to January 15, 2024 for federally facilitated marketplaces (FFM) or states using HealthCare.gov for enrollment. The annual November 1 to January 15 timeframe applies to coverage sold on and off the FFM. State-based Marketplaces, however, may establish different open enrollment periods, so check with your Marketplace.
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 although American Indians and Alaska Natives, and in most states, individuals with household income under 150 percent of the federal poverty level, may enroll year-round.
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, generally applies if the qualifying event for a special enrollment period stems from a loss of minimum essential coverage. (Note: some state-based Marketplaces may have different SEPV requirements). Individuals 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:
- Individuals who are newly ineligible for APTCs may switch to a new plan at any metal level.
- Individuals who are newly eligible or ineligible for cost sharing reductions can switch to a silver level plan.
- If there are no other plans within the same metal level, enrollees can enroll in an adjacent metal level plan (i.e., from Bronze to Silver, or Silver to Gold).
- 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, see the Center on Budget and Policy Priorities’ Special Enrollment Period Reference Chart.