Missed Open Enrollment? You Might Still Qualify for Coverage

Health insurance Open Enrollment is the time of year when anyone can sign up for a new plan or make changes to their existing coverage. Open enrollment is already closed for 2025 so if you want to make a change to your current plan or start a plan you'll have to wait till open enrollment or see if you qualify for a special election period. For 2026 plans, Open Enrollment runs from November 1, 2025, through December 15, 2025. During this window, you can compare plans, check if your doctor is in-network, and find out how much help you qualify for on your monthly premium. These changes will take effect for the new 2026 plan year.

But what if something in your life changes outside of that timeframe?

That’s where a Special Enrollment Period (SEP) comes in. If you experience certain life events, you may qualify to enroll in a Marketplace plan — even if Open Enrollment is closed.

What Is a Special Enrollment Period (SEP)?

A Special Enrollment Period lets you sign up for or change your health insurance plan after a qualifying life event or change in income. Most SEPs last 60 days from the date of the event, so it’s important to act quickly.

Below are some of the most common ways people qualify:

✅ Life Events That May Qualify You for an SEP

🔹 Changes in Household

You may qualify if you or someone in your household:

• Got married

• Had a baby, adopted a child, or placed a child in foster care

• Got divorced or legally separated and lost coverage

• Lost a family member whose Marketplace plan you were on

🔹 Moving to a New Location

You may be eligible if you:

• Moved to a new ZIP code or county and you are offered new plan options based on your change in zip code

• Moved to the U.S. from a foreign country or U.S. territory

• Changed where you live and work (seasonal workers or students)

• Moved out of transitional housing or a shelter

📝 You must have had qualifying coverage before your move unless you're coming from another country or territory.

🔹 Losing Health Coverage

You may qualify if you:

• Lost job-based coverage (including COBRA ending)

• Had an individual plan that ended or was discontinued by the health insurance company

• Aged out of your parent’s plan (usually at age 26)

• Lost Medicaid or CHIP coverage in the past 90 days

• Lost eligibility for a student health plan

• Were denied Medicaid/CHIP after applying during Open Enrollment

Note: Voluntarily dropping coverage or failing to pay premiums doesn’t qualify you for a special election period.

🔹 Changes Related to Family Coverage

You may be eligible if:

• A family member with coverage passes away and you were on the plan with them

• You are no longer a dependent due to age or other reasons

• You lose coverage through a spouse or parent due to divorce or job change

🧾 Other Situations That May Qualify

• You gain citizenship or lawful presence in the U.S.

• You leave incarceration

• You become a member of a federally recognized tribe or Alaska Native shareholder

• You start or end service with AmeriCorps, VISTA, or NCCC

• You are impacted by a federally declared disaster (like a wildfire, earthquake, or flood)

• You are offered an Individual Coverage HRA or a Qualified Small Employer HRA (QSEHRA)

📌 In most cases, you may be required to provide documents proving the life event before your plan becomes active. The most common documents needed are a COBRA notice or a Verification of Coverage letter from the health insurance company that shows your plan's end date.

Need Help? That’s What We’re Here For!

At Utah Avenue Insurance, our local agents are trained and certified to help you determine if you qualify for a Special Enrollment Period. We can walk you through the process, help gather required documentation, and make sure you enroll on time — all at no cost to you.

Whether you’ve lost coverage, moved, or had another life change, we’ll help you find a plan that fits your needs and budget. Plus we'll submit the documents for you to the Marketplace and watch to ensure they are accepted and let you know if they require more so you don't lose your coverage.

🟩 Better coverage starts here.

📞 Contact us today or stop by one of our offices to speak with a friendly, local expert who can help you navigate your SEP.