Special Enrollment Periods give you 60 days to enroll in health insurance after major life changes—even outside the annual Open Enrollment window.
Health insurance is essential for protecting both your health and your finances. Without adequate coverage, a single illness or accident can lead to thousands of dollars in medical bills. That's why it's important to understand your options for getting covered—even outside the annual Open Enrollment period.
For most people, the Health Insurance Marketplace Open Enrollment period (November 1 – January 15 in most states) is the only time to sign up for or change ACA-compliant health insurance. But if you experience certain life changes—called qualifying life events—you may be eligible for a Special Enrollment Period (SEP) that lets you enroll outside this annual window.
A Special Enrollment Period (SEP) is a window of time—typically 60 days—during which you can enroll in health insurance or change your existing coverage outside of the annual Open Enrollment period. SEPs are triggered by specific life changes called qualifying life events (QLEs).
Key points about Special Enrollment Periods:
60-day window: Most SEPs last 60 days from the date of the qualifying event (some events allow 60 days before and after)
90 days for Medicaid loss: If you lose Medicaid or CHIP coverage, you typically have 90 days to enroll in a Marketplace plan
Coverage start date: For most SEPs, coverage begins the first of the month after you complete enrollment. For birth or adoption, coverage can be retroactive to the date of the event.
Documentation required: You may need to provide proof of your qualifying life event (marriage certificate, birth certificate, termination letter, lease, etc.)
Health insurance does more than just pay for doctor visits. It protects you financially from catastrophic medical costs and ensures you have access to the care you need when you need it.
Financial protection: Without insurance, a hospital stay can cost tens of thousands of dollars. The average cost of a 3-day hospital stay is over $30,000. A broken leg can cost $7,500 or more. Health insurance caps your out-of-pocket costs—in 2026, ACA plans have a maximum out-of-pocket limit of $10,600 for an individual and $21,200 for a family.
Access to care: With health insurance, you have access to preventive care (often at no cost), routine doctor visits, prescription medications, mental health services, hospitalization, and more.
Premium subsidies: If you purchase coverage through the Health Insurance Marketplace, you may qualify for premium tax credits that significantly reduce your monthly cost. Many people pay $0 or close to $0 for a Bronze or Silver plan after subsidies.
Changes to your household are among the most common reasons for a Special Enrollment Period. These include:
Getting Married
Marriage is a qualifying life event that opens a 60-day SEP. You can add your spouse to your plan, join your spouse's plan, or shop for a new plan that covers both of you. If you enroll by the last day of the month, coverage can start the first of the next month.
Having a Baby
The birth of a child triggers a 60-day SEP. Unlike most other qualifying events, coverage for a new baby can be retroactive to the date of birth—even if you enroll in a plan up to 60 days later. This ensures your newborn is covered from day one.
Adopting a Child or Placement for Foster Care
Adoption or placement for foster care also triggers a 60-day SEP with the same retroactive coverage option as birth. Coverage can be backdated to the date of adoption or placement.
Divorce or Legal Separation
If you get divorced or legally separated and lose health coverage as a result, you qualify for a 60-day SEP. Note: Divorce or separation alone (without loss of coverage) does not qualify for an SEP in most states.
Death of a Family Member
If someone on your Marketplace plan dies and you lose your current health plan, you qualify for an SEP.
Becoming a Dependent or Gaining a Dependent Due to a Court Order
If you gain a new dependent (or become a dependent) due to a child support or other court order, you qualify for an SEP. Coverage can start on the effective date of the court order.
Losing existing health coverage is one of the most common reasons for a Special Enrollment Period. You may qualify if you lose (or will lose) coverage for reasons including:
Job loss or reduction in hours: If you lose employer-sponsored coverage due to job loss, layoff, resignation, or reduction in work hours
Aging off a parent's plan: When you turn 26 and are no longer eligible for coverage under a parent's health plan
Losing Medicaid or CHIP: If you become ineligible for Medicaid or your child ages out of CHIP (90-day SEP in most states)
COBRA coverage ending: When COBRA continuation coverage runs out
Plan discontinuation: If your current health plan is discontinued in your area
Loss of student health coverage: When you graduate or otherwise lose eligibility for a student health plan
Important: The SEP for loss of coverage can begin 60 days BEFORE the loss occurs, allowing you to enroll in a new plan before your current coverage ends—ensuring no gap in coverage. You don't qualify for an SEP if you voluntarily dropped coverage or lost coverage due to not paying premiums.
Moving to a new location can qualify you for a Special Enrollment Period, but there are specific requirements:
Moving to a new ZIP code, county, or state: If you move to an area where different health plans are available, you qualify for a 60-day SEP. This allows you to enroll in a plan with providers that are in-network in your new location.
Prior coverage requirement: To qualify, you generally must have had qualifying health coverage (Marketplace plan, employer plan, Medicaid, etc.) for at least one day during the 60 days before your move.
Moving to the U.S. from abroad: If you're moving to the United States from a foreign country or U.S. territory, you qualify for an SEP without needing prior coverage. This includes returning to the U.S. after living abroad.
What doesn't count: Moving temporarily for vacation or traveling for medical treatment does not qualify for an SEP. The move must be permanent or long-term.
Becoming a U.S. Citizen: If you obtain U.S. citizenship, you qualify for a 60-day SEP to enroll in health coverage.
Gaining Lawful Presence: If you earn a new immigration status that makes you lawfully present in the U.S., you qualify for an SEP. This includes green card holders, refugees, asylees, and others with qualifying immigration status.
Release from Incarceration: If you're released from incarceration (jail or prison), you qualify for a 60-day SEP to enroll in health coverage.
Several other situations can trigger a Special Enrollment Period:
Income changes affecting subsidy eligibility: If your income changes and you become newly eligible (or ineligible) for premium tax credits or cost-sharing reductions, you may qualify for an SEP.
Employer offering ICHRA or QSEHRA: If your employer newly offers an Individual Coverage Health Reimbursement Arrangement (ICHRA) or Qualified Small Employer HRA (QSEHRA), you qualify for an SEP to shop for Marketplace coverage.
American Indian/Alaska Native status: Members of federally recognized tribes or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders can enroll in Marketplace coverage at any time—no SEP required.
Domestic abuse or spousal abandonment: Survivors of domestic abuse or spousal abandonment can enroll in their own health plan separate from an abuser or abandoner.
Natural disasters and emergencies: If a natural disaster (hurricane, flood, earthquake) or other emergency prevented you from enrolling during Open Enrollment, you may qualify for an SEP. You typically have 60 days from the end of the FEMA-designated incident period.
Marketplace or insurer error: If misinformation, misconduct, or errors by the Marketplace, an insurance company, agent, broker, or navigator prevented you from enrolling, you may qualify for an SEP.
In most states, pregnancy alone is NOT a qualifying life event for a Special Enrollment Period on HealthCare.gov. However, several state-run Marketplaces have created pregnancy-triggered SEPs:
New York, California, Maryland, New Jersey, Rhode Island, Vermont, Colorado, Connecticut, Washington D.C.
Illinois and Virginia will offer pregnancy SEPs starting in 2026
North Carolina uses HealthCare.gov and does not currently offer a pregnancy-triggered SEP. However, once the baby is born, the birth triggers a 60-day SEP with retroactive coverage available to the date of birth.
Tip: If you're pregnant and uninsured, check if you qualify for Medicaid. In North Carolina, pregnant women may be eligible for Medicaid with income up to 196% of the federal poverty level. Medicaid enrollment is available year-round.
If you've experienced a qualifying life event, here's how to enroll:
Act quickly. Most SEPs last only 60 days from your qualifying event. Don't wait until the last minute.
Gather documentation. You may need to provide proof of your qualifying life event, such as a marriage certificate, birth certificate, employer termination letter, or a lease showing your new address.
Apply through HealthCare.gov or your state Marketplace. Create an account (if you don't have one) and complete an application. You'll indicate your qualifying life event during the application process.
Compare plans. Review available plans, considering premiums, deductibles, out-of-pocket maximums, provider networks, and prescription drug coverage.
Enroll and pay your first premium. Your coverage doesn't start until you pay your first premium. Coverage typically begins on the first of the month after you enroll.
Need help? You can call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) or work with a licensed insurance agent to help you find and enroll in a plan.
If you experience a qualifying life event and don't enroll during your Special Enrollment Period, you'll generally have to wait until the next Open Enrollment period to get coverage. That could mean months without health insurance.
Exceptions that allow year-round enrollment:
Medicaid and CHIP: Enrollment is available year-round based on eligibility
American Indians and Alaska Natives: Can enroll in Marketplace coverage at any time
Short-term health insurance: Available year-round in many states (but these plans have significant limitations and don't cover pre-existing conditions)
Understanding whether you qualify for a Special Enrollment Period—and choosing the right health plan—can be complicated. Our licensed health insurance agents in North Carolina are here to help.
We can help you:
Determine if your situation qualifies for a Special Enrollment Period
Understand the documentation you need to provide
Compare plans and find coverage that fits your needs and budget
Check if you qualify for premium subsidies or cost-sharing reductions
Enroll in a plan before your SEP window closes
Contact Health Plans of NC at 1-800-797-0327 to speak with a local agent about your health insurance options. Our services are free.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a window of time—usually 60 days—during which you can enroll in health insurance or change your coverage outside of the annual Open Enrollment period. SEPs are triggered by qualifying life events like marriage, having a baby, losing health coverage, or moving to a new area.
How long do I have to enroll during a Special Enrollment Period?
Most SEPs last 60 days from the date of your qualifying life event. For loss of Medicaid or CHIP, you typically have 90 days. Some events (such as the loss of employer coverage) allow you to start enrolling 60 days before the loss occurs.
Is getting married a qualifying life event?
Yes. Marriage is a qualifying life event that triggers a 60-day Special Enrollment Period. You can add your spouse to your plan, join your spouse's plan, or shop for new coverage together.
Is pregnancy a qualifying life event?
In most states, including North Carolina (which uses HealthCare.gov), pregnancy alone does not trigger a Special Enrollment Period. However, the baby's birth qualifies, and coverage can be retroactive to the date of birth. You may also qualify for Medicaid during pregnancy.
What happens if I miss my Special Enrollment Period?
If you miss your SEP window, you'll generally have to wait until the next Open Enrollment period (November 1 – January 15 in most states) to enroll in ACA-compliant coverage. You may still be able to enroll in Medicaid or CHIP year-round if eligible, or consider short-term health insurance as a temporary solution.
Do I need to provide proof of my qualifying life event?
Yes, you may need to provide documentation. For loss of coverage, you'll typically need a letter from your previous insurer or employer. For marriage, a marriage certificate. For a new baby, a birth certificate. For moving, a lease or utility bill at your new address. The Marketplace will let you know what documents are required.