Open Enrollment vs. Special Enrollment

You cannot buy a Marketplace plan on any day you choose. You can buy during open enrollment, once a year, or during a special enrollment period, which opens only after a qualifying life event. Understanding which window you are in, and how long it lasts, is the difference between getting covered and waiting until next year.

Open enrollment dates, including state differences

The federal dates are November 1 through January 15, with the December 15 cut-off for January 1 coverage and later enrollments starting February 1. State-run marketplaces set their own dates, and several run longer: California, the District of Columbia, New York, and Rhode Island run to January 31, Massachusetts to January 23, and Virginia to January 29, while Idaho ends on December 15. Those state dates are reported figures for the current enrollment season and can change, so your own marketplace's calendar is the only one to rely on. The practical rule is simple: enroll by December 15 if you want January 1 coverage, and do not leave it to the last day of any window, when websites and phone lines are busiest.

Qualifying life events that open special enrollment

• Losing other coverage. Losing job-based coverage, aging off a parent's plan at 26, losing Medicaid or children's coverage, or exhausting COBRA. You can generally apply up to 60 days before the loss and 60 days after it.
• Getting married or divorced. Marriage opens a window for the couple; divorce that causes a loss of coverage opens a window for the person who loses it.
• Having or adopting a child. Birth, adoption, or placement for foster care opens a window, and coverage for the child can generally start on the date of the event.
• Moving. Moving to a new area with different plans, moving to the United States from abroad, or moving out of a coverage area can qualify, usually with proof of prior coverage.
• Other events. Gaining citizenship or lawful presence, leaving incarceration, a Marketplace error, a plan violating its contract, or a change in income or household that changes eligibility for subsidies or Medicaid can also qualify.

What does not count

Voluntarily dropping a plan does not open special enrollment. Stopping COBRA payments by choice does not either, unless your COBRA has run out. Missing open enrollment because you forgot, getting sick, or deciding you want a better plan are not qualifying events. Neither is losing coverage because you did not pay premiums, or because your plan was rescinded for fraud. The system is deliberately narrow: it has to be, or there would be no reason to enroll during open enrollment, and only sick people would buy, which would raise prices for everyone.

Proof and timing

Most special enrollment applications require documents: a letter showing your old coverage ended, a marriage certificate, a birth certificate, or proof of a move. You usually have 30 days to provide them after you pick a plan, and your coverage can be delayed or ended if you do not. Coverage start dates vary: loss-of-coverage enrollments generally start on the first day of the month after you pick a plan, while birth and adoption coverage can start on the event date. If you are in a special enrollment window, apply early in the 60 days, not at the end, because a document problem at day 59 leaves you no time to fix it.

Sources: HealthCare.gov, open enrollment and special enrollment period pages; Centers for Medicare & Medicaid Services, enrollment period guidance; 45 CFR section 155.420 (special enrollment periods).