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Special Enrollment Period

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Do I Qualify for a Special Enrollment Period?

When life brings change, your health coverage may need to change too. Under the Affordable Care Act (ACA) there are rules about when you can make mid-year changes to coverage. Now that the Open Enrollment Period has ended (Dec. 15), you can only make changes to your coverage if you experience a qualifying life event. Learn more below.

Qualifying Life Events

You may qualify to enroll through a Special Enrollment Period if one of the following applies to you.

If there was a change to your household or family structure, you may qualify for a Special Enrollment Period.

Examples include:

  • Getting married
  • Had a baby or adopted a child
  • Had a child placed for foster care
  • Getting divorced or legally separated and lost health insurance
  • Death in the family and lost health insurance as a result

If you permanently moved, you may qualify for a Special Enrollment Period.

Examples of qualified moves include:

  • Moving to a different ZIP code or county
  • Moving to the U.S. from another country
  • Student moving to or from the place they attend school

Note: In addition to moving, you also must prove you had qualifying health coverage for one or more days during the 60 days before your move.

If you or anyone in your household involuntarily lost their health coverage, you may qualify for a Special Enrollment Period.

Examples of involuntary loss of coverage include:

  • Losing employment-based health insurance
  • Losing individual health insurance
  • Losing eligibility for public insurance coverage such as Medicare, Medicaid or CHIP

Note: Voluntarily ending your health coverage or being terminated for not paying your premiums are not considered involuntary loss of coverage.

Other complicated or less common situations may also qualify you for a Special Enrollment Period.

Examples include:

  • Becoming a U.S. citizen
  • Released from prison
  • Experience a Marketplace enrollment error
  • Changes to your income that could make you eligible to enroll in a different type of coverage, either individual or a public insurance program like Medicaid or CHIP
  • Determined ineligible for Medicaid or CHIP

Your state's Health Insurance Marketplace will have a complete list.

Change  Making changes to your coverage

If you believe one of the life events above applies to you, here's what you need to know.

You must work with your state’s Health Insurance Marketplace to change or update your coverage. Typically, you must request changes to your coverage within 60 days of the event date.

Follow our three-step process to request changes >

You must request changes to your coverage within 60 days of the event date.

Follow our three-step process to request changes >

Were Here to Help

There are several options for getting help.

Iowa, Kansas, Nebraska, North Dakota, Missouri, Oklahoma and Wisconsin Residents:
Call the Health Insurance Marketplace Call Center
1-800-318-2596 (TTY: 1-855-889-4325).
Available 24 hours a day, 7 days a week (except holidays)

Minnesota Residents:
Call MNsure’s Call Center
1-855-366-7873 (TTY: 711)
8 a.m. to 6 p.m. Central, Monday-Friday
10 a.m. to 2 p.m. Central, Saturday

If you work with a licensed agent or broker, they are your best resource for answering questions and helping you enroll in coverage.

Interested in working with an agent or broker? Find one near you.

Find an Agent >

You may work with one of our specially trained sales consultants.

Call
1-800-670-5935 (TTY: 711)
8 a.m. – 5 p.m. Central, Monday – Friday
(Closed 8 – 9 a.m. Fridays)

Email
MedicaIndividualProducts@medica.com

You may work with a certified application counselor, navigator, clinic or hospital-based financial counselor to answer your questions and help you enroll in coverage.

Iowa, Kansas, Nebraska, North Dakota, Missouri, Oklahoma and Wisconsin Residents:
Visit the Health Insurance Marketplace (HealthCare.gov) to find help in your area.
Find help >

Minnesota Residents:
Visit MNsure (MNsure.org) to find help in your area.
Find help >

Date: 8/24/2019 9:56:32 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01