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Missed Individual Health Open Enrollment? You May Qualify Under the Special Enrollment Period

Employee Benefits, Personal Lines

Open Enrollment for individual health coverage came to a close on January 15th, 2022. Every year, the health coverage marketplace has an Open Enrollment Period for individuals to change coverages, or sign up for a new plan. If you missed the deadline for the Open Enrollment Period, you may still qualify under the Special Enrollment Period.

M3 Elevate is here to guide you through the Special Enrollment Period based on your specific situation. The following information outlines which individuals do and don’t qualify based on life events and changes.

What is the Special Enrollment Period?

The Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. Depending on your Special Enrollment type, you may have 60 days before or 60 days following the life event/change to enroll in a plan.

Life events that qualify under the Special Enrollment Period

  • Losing health coverage through an employer
    • Employer ends coverage
    • Leaving a job where you had health coverage, voluntary or involuntary/fired
    • What doesn’t qualify: Employee voluntarily drops coverage while still working for the employer, or employee doesn’t pay the premium, which results in the loss of coverage
  • Losing health coverage through a family member
    • Turning 26 and can no longer be on a parent’s health plan
    • Losing job-based coverage from a family member’s employer
    • What doesn’t qualify: Family member carrying the coverage voluntarily drops coverage, or they don’t pay the premium, which results in the loss of coverage
  • Losing COBRA coverage
    • Former employer stops contributing to your COBRA coverage or your COBRA coverage runs out
    • What doesn’t qualify: Employee decides to end COBRA coverage early and pay the full cost themselves, or loss of COBRA coverage because employee doesn’t pay the premium
  • Moving
    • Student moving to attend school
    • Moving to a new county or ZIP code
    • Moving to/from a shelter or other transitional housing
    • What doesn’t qualify: Moving for medical treatment, or staying on an extended vacation
  • Household change in size
    • Getting married
    • Getting divorced or legally separated
    • Having a baby or adopting a child
    • Death

Additional events that qualify under the Special Enrollment Period

  • Gaining membership in a federally-recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

If you qualify for a Special Enrollment Period resulting from a recent life event, you may be required to submit documents showing proof of your life event. The documents need to be submitted within 30 days.

How do I Know if my Special Enrollment is Confirmed?

Special Enrollment confirmed

If your Special Enrollment Period is confirmed, the Marketplace will send confirmation to the insurance plan that you selected. You will need to pay your first premium directly to the insurance company, not to the Marketplace. Coverage will not begin until you pay your first premium.

Special Enrollment not confirmed

If your Special Enrollment Period can’t be confirmed when submitting documents, you’ll get a letter or notice in your Marketplace account with an explanation. You can upload more documents to confirm. If you don’t have any of the acceptable documents, you can write a written letter explaining why.


Reminder: The Open Enrollment for 2023 coverage begins November 1, 2022 to December 15, 2022. The Open Enrollment for 2023 coverage will go into effect January 1, 2023.

Key Takeaways:

Open Enrollment for individual health coverage ended on January 15th, 2022, but you may qualify for the Special Enrollment Period.

The following life events may allow you to qualify for the Special Enrollment Period:

  • Loss of health coverage through an employer or family member,
  • Loss of COBRA coverage,
  • Change in location; and
  • Change in family size.

Documentation for proof of life event needs to be submitted within 30 days.

For further guidance on the Special Enrollment Period, contact Natalie Damro

Source: healthcare.gov

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