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Special Enrollment Period

If you experience a major life change, it could affect your health insurance coverage.

  • If you are uninsured, you may be able to get insurance
  • If you have coverage, you may be able to change plans
  • If you have coverage through NY State of Health or have a problem with that coverage, your insurance may be affected differently.

Some life changes trigger what is called a "special enrollment" period. Special enrollment lets you get or change your private coverage outside of open enrollment. Special enrollment periods can be as short as 30 days, so you should act fast. The New York State of Health (NYSOH) has issued Frequently Asked Questions (FAQ) on Special Enrollment Periods for consumers to understand their options and how to action in order to avoid penalties.

Life changes include:

  • Losing job-based health insurance  
  • Moving permanently to New York State or moving within the State that makes new health plans available to you
  • Getting married or entering into a domestic partnership
  • Getting divorced or legally separated
  • Getting pregnant - pregnancy is certified by a health care practitioner
  • Having a baby or adopting of a child, or placement of a child in foster care
  • Becoming eligible or ineligible for financial help to pay for your  Qualified Health Plan coverage
  • Becoming a US citizen, national or lawfully present individual

Take Action if you have coverage through the NY State of Health individuals & families marketplace, or through an insurer in the individual market outside of the marketplace, you only have sixty days (60) after a life changing event to make changes to your insurance or enroll in a health plan. To avoid a gap in coverage, if you are losing health insurance, you can apply for a new plan as early as 60 days before your current insurance will end.

If you are enrolled in health insurance through a job (group coverage), you may only have thirty days (30) after the qualifying event to make changes to your coverage.

In some cases when a qualifying event makes you lose coverage, you may be able to claim an exemption to avoid paying a penalty for the time you are uninsured.

Remember, during Open Enrollment, everyone can enroll in health insurance or change their health plan.