Life events that typically earn congratulations or elicit sympathy might get you something else: the chance to buy health insurance in the Obamacare marketplaces outside the official open enrollment period.
Getting married, having a baby, losing a job and other milestones -- or, qualifying life events in Obamacare terminology -- can get you a special enrollment period that allows you to buy coverage before the next open enrollment period starts Nov. 15. At that point, the health insurance marketplaces open to everyone for three months.
Nearly 7 million Americans -- including 2.7 million who are uninsured and 4 million who have coverage -- will likely qualify to shop the marketplaces before the next open enrollment period, according to a new report from Enroll America, a nonprofit focused on helping Americans get and keep health coverage.
In the marketplaces, you have 60 days after a qualifying life event to apply for a special enrollment period, according to HealthCare.gov.
"Those without insurance get a new opportunity to seek coverage while those with insurance get an opportunity to change plans," says Zach Baron, senior policy analyst for Enroll America.
One note: certain Americans, such as American Indians and Alaska Natives can enroll year round.
For everyone else, here are nine ways to get an exception to the Obamacare open enrollment rules.
1. Get married.
When you tie the knot, you change your family size and possibly your household income. That could affect your eligibility for subsidies to offset the cost of premiums.
Shopping for health insurance? Use our Obamacare subsidy calculator to see if you qualify for a price cut on your premium.
So, newlyweds should seek free, in-person help and shop the marketplaces, Baron says.
2. Have a baby.
Giving birth, or adopting or fostering a child, can qualify you for a special enrollment period, according to HealthCare.gov. When a little one arrives, the whole family can shop for coverage, which will kick in immediately with no coverage gap, Baron says.
For most other shoppers, new coverage takes up to a few weeks to start -- either on the first or the 15th of the month.
If you move outside of your plan coverage area -- whether it's across the country or to the next county -- you can shop the marketplace, says Craig Gussin, a California health insurance agent.
For example, if you move from the East Coast to California and your plan doesn't work there, you can shop for a new plan, Gussin says.
4. Lose your insurance.
Losing group coverage -- whether because your employer drops coverage or you lose your job -- is one of the most common reasons to get a special enrollment period, says Doug Foshee, business development manager of Health Partners America, a company that helps health insurance brokers learn about and adapt to the Affordable Care Act.
That includes getting dropped from a parent’s plan because you turned 26, according to Young Invincibles, a nonprofit that represents the interests of 18-to-34-year-olds.
Young Invincibles recommends checking with the parent’s insurer, though, because some companies may extend coverage past your birthday.
5. Get divorced.
"You can't stay on your spouse's insurance after a divorce," Gussin says. If you’re the spouse losing coverage, you can get coverage through COBRA through their ex-spouse's employer, or get an individual plan, which almost always is cheaper, Gussin says.
The cost of COBRA depends on the premium for your plan: you pay 100 percent of it, because the employer no longer covers part of it, along with up to two percent extra for administrative costs, according to the U.S. Department of Labor.
Shop before the divorce is finalized to avoid a gap in coverage, he says.
6. Have a change in income.
If your hours get cut or you get a raise, it's a good idea to go back to your state's marketplace to shop the plans, Baron says, noting that a change in income can affect your eligibility for programs such as Medicaid, as well as for subsidies to help pay premiums. A change in income could also qualify you for a special enrollment period in certain situations, he says.
7. Become a legal U.S. resident.
Any immigration status change might qualify you for a special enrollment period, according to HealthCare.gov. This could include a variety of scenarios, such as getting lawful permanent resident status or being granted asylum.
Asylum is when the U.S. government offers protection to citizens of other countries who at home faced persecution based on race, religion, nationality or politics, Baron says.
8. Get out of prison.
The end of a period of incarceration can qualify you for a special enrollment period, according to HealthCare.gov. Prisoners get medical care provided in prison, but they can shop the marketplaces when they get out, Baron says.
9. Experience exceptional circumstances.
This catchall exception allows you to shop for insurance if you couldn't get it during the enrollment period due to an extreme situation, including:
- You were unexpectedly hospitalized.
- You had a temporary cognitive disability.
- You got misinformation from an insurance company.
- You were a victim of domestic violence.
- You were affected by a natural disaster.
How do you get a special enrollment period?
To apply, go to the online marketplace for your state -- preferably with help from a navigator, certified application counselor or health insurance broker -- and fill out an application, which will ask a series of questions about your circumstances.
However, a warning: You attest under penalty of perjury that the information you give is true, Baron says.
But you probably won't have to provide documentation -- like a marriage license, birth certificate or pink slip -- of your qualifying event, at least right now, though it might vary by state.
However, the IRS will check to make sure you had a qualifying event, and, if you didn't, you'll likely have to pay back any subsidy you got between the time you enrolled and the next open enrollment period, Foshee says.
"Tax season will be when they figure out if you really had a qualifying life event," he says.