Special Enrollment Periods: Getting Health Coverage Outside Open Enrollment

What a Special Enrollment Period Is

Marketplace health insurance has one main sign-up window each year. In Idaho, open enrollment for 2027 coverage runs October 15 to December 15, 2026. Outside it, you need a Special Enrollment Period, a limited window opened by a Qualifying Life Event. With an SEP you can buy coverage, and you can apply for a premium tax credit, at any time of year. If you already have an ACA marketplace plan, an SEP may also let you change it.

This guide is about marketplace coverage for people under 65. Medicare has its own, different Special Enrollment Periods, covered in our Medicare enrollment periods guide.

Qualifying Life Events

Common Qualifying Life Events include:

• Loss of current coverage, for example job loss or turning 26 and leaving a parent’s plan.
• Loss of Medicaid.
• Moving to Idaho or within Idaho.
• Birth or adoption, a new household member.
• Marriage or divorce, a change in household.
• Unaffordable employer coverage for you, your spouse or dependents.
• American Indian or Alaska Native status, which allows enrollment year-round.
• Exceptional circumstances, reviewed case by case.
• An HRA offered by an employer (a health reimbursement arrangement).

The federal rules add useful detail:

• Losing coverage: you can qualify if you lost qualifying coverage in the past 60 days or expect to lose it in the next 60 days. Job-based coverage and COBRA both count. Dropping coverage on your own does not.
• Divorce or legal separation qualifies only if you lose health coverage because of it.
• Moving generally means a new ZIP code or county. Moving only for medical treatment or a vacation does not qualify.
• Birth or adoption: coverage can start the day of the event, even if you enroll up to 60 days afterward.

The ACA qualifying event finder walks through these questions for your situation.

60 Days, 90 Days and When Coverage Starts

You have 60 or 90 days after a Qualifying Life Event, depending on the event, to enroll or make changes. Under the federal rules, the general window is 60 days, and losing Medicaid or CHIP gives 90 days.

Coverage start dates depend on the event. Under the federal rules, if you get married and pick a plan by the last day of the month, coverage can start the first day of the next month; for birth or adoption it can start on the day of the event. For loss of coverage, enrolling before the old coverage ends is the surest way to avoid a gap. We confirm your effective date with you before the window closes.

What Changed for 2026

In recent years, people with household income at or below 150% of the federal poverty level could enroll in or change marketplace plans any month. CMS’s 2025 Marketplace Integrity and Affordability final rule ended that monthly low-income SEP for plan year 2026 onward.

Two other things to keep in mind. The enhanced premium tax credits also expired after 2025, so your credit may be smaller than before; see premium tax credits. And Medicaid does not use open enrollment: if your income is low, we check whether you qualify and help you apply at any time.

Documents to Keep

A special enrollment has two steps: we submit your application and supporting documents, then you choose or update your plan. Keep these handy:

• Loss of coverage: a letter from your employer or insurer showing the coverage end date, or a COBRA notice.
• Move: a lease, mortgage statement or utility bill showing your new address and date.
• Marriage: your marriage certificate.
• Birth or adoption: a birth certificate or adoption records.
• Loss of Medicaid: the notice showing your Medicaid end date.

Gather them early. A missing document can hold up your enrollment.

How We Use Your SEP

1. Note the date of your event and count forward 60 (or 90) days.
2. Compare your options. If you are losing job coverage, compare COBRA, which the U.S. Department of Labor says can cost up to 102% of the plan’s cost, with an ACA marketplace plan after any tax credit.
3. Call or text us at 208-350-9933. We report the change, submit your application and upload your documents with you.
4. Choose a plan and pay the first premium to the insurance company so coverage takes effect.

For how the ACA marketplace works overall, see the ACA health insurance marketplace in Idaho, and for plan options, our ACA / Marketplace page.

Frequently Asked Questions

Related Guides

• The ACA Health Insurance Marketplace: How It Works in IdahoHow ACA marketplace plans work, the 2027 open enrollment dates, and how we enroll you.
• Premium Tax Credits in 2026 and 2027: Who Qualifies and How MuchThe 400% limit, the 2026 and 2027 percentages, and year-end reconciliation.
• ACA Metal Levels Explained: Bronze, Silver, Gold and PlatinumWhat each tier pays, cost-sharing reductions on Silver, and the 2026–2027 caps.

Coverage pages for this topic: ACA / Marketplace. Other topics in the Learning Center: Medicare, Life Insurance, Final Expense, Annuities, Long-Term Care, Disability Insurance, Supplemental Health, Short-Term Medical, Travel Insurance.