Outside open enrollment, you can only buy a Marketplace plan if you qualify for a special enrollment period. Most people have heard of it, but the rules are narrower than they sound. Here's what usually counts and what doesn't.
What a special enrollment period is
It's a window, usually 60 days, that opens after a qualifying life event. During that window you can enroll in a Marketplace plan or change plans even though open enrollment is closed. You'll typically need to show proof of the event.
Events that commonly qualify
- Losing job-based coverage. This includes losing a job, having your hours cut so you lose benefits, or your employer ending the plan.
- Aging off a parent's plan. Turning 26 ends coverage on a parent's plan and opens a window. See our guide on turning 26.
- Getting married.
- Having or adopting a baby.
- Moving to a new area where different plans are available, in many cases when you already had coverage before the move.
- Losing other qualifying coverage, such as Medicaid or CHIP eligibility ending.
Situations that usually don't qualify
- Missing the deadline or not knowing about it.
- Deciding your premium is too high. Cost alone doesn't open a window.
- Losing coverage because you stopped paying premiums.
- Dropping COBRA on your own outside open enrollment. We cover this in COBRA vs. Marketplace vs. private PPO.
What to have ready
Keep the paperwork that shows the date and the event, for example a termination letter or the notice that your coverage ended, a marriage certificate, or a birth record. Missing documents are a common reason an application stalls.
If you don't qualify
You have two realistic options. You can wait for the next open enrollment, which can leave you uncovered for months. Or you can look at private PPO plans, which aren't tied to the Marketplace calendar. They ask health questions and can limit or decline coverage, so they aren't right for everyone, but they're worth comparing.
This article is general information, not a guarantee of coverage or pricing. Plan availability, benefits, and eligibility vary by state and individual. Some private plans are medically underwritten and do not include all ACA essential health benefits.