Triggering Events for a Special Enrollment Period

Normally you will only be able to apply for ACA plans only during the open enrollment period. An exception is if there is a qualified triggering event. In the case of a triggering event, a Special Enrollment Period (SEP) is opened. Events that permit a SEP include but are not limited to:

  • Gaining or becoming a dependent
  • Gaining status as a citizen, national, or lawfully present individual
  • Loss of minimum essential coverage (e.g., loss of Medicaid eligibility, termination of a QHP), except if enrollment is terminated based on failure to pay premiums
  • Loss of affordable employer-sponsored coverage
  • Determination that an individual is newly eligible or ineligible for premium tax credits or a change in eligibility for cost-sharing reductions
  • Permanent move to an area where different QHPs are available
  • Other exceptional circumstances identified by the Marketplace

In most cases, Special Enrollment Periods will extend for 60 days from the date of the triggering event. Under certain circumstances, such as the pending loss of minimum essential coverage due to the termination of a QHP, a SEP may begin before the triggering event takes place.


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