An ACA special enrollment period is a window, usually 60 days, when you can sign up for or change a Marketplace health plan outside open enrollment because of a qualifying life event, such as losing coverage, moving, getting married or having a baby. Without one, you can only enroll in a Marketplace plan during open enrollment, which runs November 1 to January 15 on HealthCare.gov.
The rules changed in 2025 and 2026. The monthly window for people with income up to 150% of the poverty level was removed for 2026, and a 2025 tax law cut off premium tax credits for plans picked through income-based windows. Rules that would have required documents before enrollment for most special enrollment periods were blocked in court. This guide explains the events that qualify, the deadlines, the documents, and the current status of each change as of October 18, 2026.
Which life events qualify for a Special Enrollment Period?
HealthCare.gov lists these common events, as checked October 18, 2026. The list is not complete; the Marketplace application asks about others.
| Type | Examples that can qualify | Examples that do not qualify |
|---|---|---|
| Loss of health coverage | Losing job-based coverage, COBRA running out, losing Medicaid or CHIP, turning 26 on a parent’s plan, an individual plan being discontinued | Voluntarily dropping coverage; losing coverage because you stopped paying premiums |
| Changes in household | Marriage; birth, adoption or foster placement; divorce or legal separation that ends your coverage; death of someone on your plan | Divorce that does not change your coverage |
| Changes in residence | Moving to a new ZIP code or county; moving to the US from abroad or a territory; students and seasonal workers moving | Moving only for medical treatment; staying somewhere on vacation |
| Other events | Becoming a US citizen; leaving incarceration; gaining membership in a federally recognized tribe; starting or ending AmeriCorps service; an offer of an individual coverage HRA or QSEHRA from an employer | Simply missing open enrollment |
HealthCare.gov also lists special situations such as a serious illness or a natural disaster that kept you from enrolling, enrollment errors by someone helping you, and domestic abuse or spousal abandonment.
How long do you have to enroll?
For most events you have 60 days. The exact window depends on the event.
| Event | When you can pick a plan | When coverage usually starts |
|---|---|---|
| Losing job-based or individual coverage | Up to 60 days before and 60 days after the loss | First of the month after the old coverage ends (if you pick in advance) or after you pick |
| Losing Medicaid or CHIP | Up to 90 days after the coverage ends | First of the month after you pick |
| Marriage | Within 60 days | First of the month after you pick (pick by the last day of a month) |
| Birth, adoption or foster placement | Within 60 days | The day of the event |
| Moving | Within 60 days of the move | First of the month after you pick |
| FEMA-declared disaster that kept you from enrolling | 60 days from the end of the FEMA incident period | You can ask for the date you would have picked a plan |
Sources: HealthCare.gov Special Enrollment Period pages, checked October 18, 2026.
Do you need prior coverage to qualify?
For some events, yes. Federal rules (45 CFR 155.420) generally require that you had qualifying coverage for at least one day in the 60 days before:
- A move. Exceptions include moving from a foreign country or a US territory.
- A marriage. At least one spouse must have had qualifying coverage for at least one day in the 60 days before the wedding.
American Indians and Alaska Natives, and people who recently lived in an area where no Marketplace plan was offered, are also exempt. Events like a birth or adoption do not have a prior-coverage requirement.
What documents do you need?
When you apply, you attest that your information is true. The Marketplace may then ask you to confirm the event with documents. HealthCare.gov’s process, as checked October 18, 2026:
- Pick a plan first. HealthCare.gov recommends picking a plan before sending documents.
- Send documents within 30 days of picking a plan, by upload (fastest) or by mail. Send copies, not originals.
- Wait for confirmation. A letter in your account, usually within a couple of weeks, says whether the Special Enrollment Period is confirmed.
- Pay your first premium to the insurance company. Your coverage cannot be used until eligibility is confirmed and the first premium is paid.
Examples of acceptable proof for a loss of coverage include a letter from your employer or insurer showing the coverage and its end date. If you have no acceptable documents, HealthCare.gov lets you send a letter of explanation.
What happened to stricter document checks?
The 2025 Marketplace Integrity and Affordability rule would have required HealthCare.gov to verify eligibility for most Special Enrollment Periods before enrollment. A federal court stayed that provision on August 22, 2025, and vacated it on June 12, 2026. A similar requirement in the 2027 payment rule was stayed on July 16, 2026, according to State Health and Value Strategies. As of October 18, 2026, HealthCare.gov describes the pick-a-plan-then-send-documents process above.
What happened to the low-income monthly Special Enrollment Period?
Before August 2025, people with expected income up to 150% of the federal poverty level could enroll or change plans in any month. Two changes ended that:
- The 2025 rule. CMS removed this monthly SEP effective August 25, 2025. CMS training slides say the removal applies to plan year 2026, that a change in income is not treated as an “exceptional circumstance,” and that state exchanges may not offer income-based SEPs to work around the rule.
- The 2025 tax law. Section 71304 of Public Law 119-21 says that for plan years beginning after December 31, 2025, a plan picked during a Special Enrollment Period based on a change in expected income does not count for the premium tax credit, according to IRS proposed regulations scheduled for publication October 15, 2026.
The CMS slides say the regulatory removal sunsets at the end of 2026, but because of the tax law, coverage picked through an income-based SEP would not get the tax credit. As of October 18, 2026, we found no official notice offering this SEP with tax credits for 2027. If your income is low, plan to enroll during open enrollment, or check whether you qualify for Medicaid, which accepts applications all year.
Can you change plans with a Special Enrollment Period?
Yes, but often only within the same metal level. HealthCare.gov says that people who already have a Marketplace plan and qualify through the most common events, such as a loss of coverage, a move or a change in household size, can only pick a new plan in their current category. Exceptions include:
- Newly qualifying for cost-sharing reductions: you can move to a silver plan.
- Losing cost-sharing reductions: you can pick a bronze, silver or gold plan.
- New household members: a new spouse or child can join your plan or enroll in any plan on their own.
Our guide to ACA metal levels explains what each category means.
Common situations, step by step
- Turning 26: you lose coverage on a parent’s plan, which qualifies. You can pick a plan up to 60 days before or after.
- Having a baby: add the baby within 60 days. Coverage can start on the day of birth.
- Getting married: pick a plan within 60 days; at least one spouse needs prior coverage in the 60 days before the wedding.
- Moving to a new state: apply in your new state’s Marketplace. If it runs its own exchange, apply there.
- Leaving COBRA early: voluntarily dropping or no longer paying COBRA does not qualify. COBRA running out does.
How do Special Enrollment Periods work in state exchanges?
States that run their own exchange follow the same federal framework, but they can differ in the details: some offer extra Special Enrollment Periods, set their own document rules, or use different deadlines. For example, a state exchange may open a special window after a local emergency. If you live in a state with its own exchange, such as California, New York, New Jersey or Pennsylvania, or Oregon starting with 2027 coverage, check that exchange’s website for its list of qualifying events and deadlines. The CMS rule removing the 150% SEP said state exchanges may not offer income-based windows to work around it for 2026.
Mistakes that cost people coverage
- Waiting until the last week. Document requests take time. Pick a plan early in your 60-day window.
- Missing the first premium. Coverage does not start until it is paid.
- Assuming a new job means new coverage right away. Job-based plans often have a waiting period; a Marketplace plan can bridge the gap if you have a qualifying loss of coverage.
What if you do not qualify?
If you have no qualifying event, you have three main options:
- Apply for Medicaid or CHIP. You can apply any time of year.
- Check job-based coverage. Employer plans must offer a Special Enrollment Period of at least 30 days after certain events, and employers set their own open enrollment.
- Wait for open enrollment. The next HealthCare.gov window opens November 1, 2026, for coverage starting January 1, 2027. You can preview plans now with our ACA plan finder.
If the Marketplace turns down your request and you think you qualify, you can appeal. Instructions are in your eligibility notice.
All rules were checked on HealthCare.gov, CMS, the eCFR and the Federal Register on October 18, 2026. Court cases on these rules are ongoing, so confirm current rules on HealthCare.gov or your state’s exchange. We are an independent publication, not an enrollment site or government agency; this is not legal or insurance advice.
