Special Enrollment: When Is It and How It Works

From “I do” to “I moved,” special enrollment is an opportunity to enroll in a health insurance plan outside of the regular open enrollment period—if you have a qualifying life event. Major life changes like getting married or changing jobs allow you to enroll in a health plan through Covered California year-round. Common events also include losing coverage (like Medi-Cal), having or adopting a child, leaving a parent’s plan, and more.

This guide explains exactly what special enrollment is, who qualifies, what deadlines apply (typically 60 days), how to get free help, and more.

What Is Open Enrollment

When it comes to Covered California, our open enrollment runs annually from November 1 through January 31. That’s your window to sign up, renew, or shop coverage through Covered California. If you miss it? You’ll likely need to wait until the next cycle—unless life throws you a qualifying plot twist.

That’s where special enrollment comes in.

Of course, open enrollment deadlines depend on where you get your health insurance. Learn more about that for Medi-Cal, Medicare, and employer-based coverage, plus everything else you should know about open enrollment, here.

What Is Special Enrollment

The reason you kept reading: special enrollment!

Special enrollment kicks in when life flips the script, such as getting laid off, COBRA coverage ending, welcoming a new child, or moving to a new ZIP code. Special enrollment lets you enroll in, switch, or update your health plan through Covered California. You usually have 60 days from the event to act; please don’t wait!

Qualifying for Special Enrollment

You qualify for special enrollment if you (or anyone in your household with health coverage) has a major life change. Some of the most common ones are listed below:

Loss of Coverage

• Losing your job-based coverage (layoff, reduced hours)

• Losing individual coverage (your plan ends, insurer leaves your area)

• Losing student health coverage

• Age out of a parent’s plan at 26

• Losing Medi-Cal eligibility

• End of COBRA coverage

Changes In Household Size

• Birth, adoption, or foster care

• Marriage or domestic partnership

• Death of a household member that affects eligibility

Moving To or Within California

• Moving to a new ZIP code

• Moving to California from another state or country

• Students moving to/from school

• Seasonal workers moving for work

Changes in Eligibility or Status

• Income changes that qualify you for financial help

• Income changes that make you ineligible for Medi-Cal

Pro tip: If your qualifying event falls under loss of coverage or moving, you can usually apply up to 60 days before coverage ends to avoid a gap.

View the full list of qualifying events here.

Applying for Special Enrollment

When life happens, coverage can too. You don’t have to wait! Apply for a health plan outside of open enrollment (or make changes to your current plan) if you’ve experienced a qualifying event.

Applying takes about 30 minutes, start to finish. Here’s what you should know before you start:

Deadlines

You’ve got time, but not a lot. Most major life changes give you a 60-day window to enroll, starting from the date the qualifying event occurred. Some events, like loss of coverage, allow you to apply up to 60 days ahead to avoid a gap. After the 60-day window, you can still enroll in a health plan during the next available open enrollment.

Again:

• For most events, you have 60 days from the day it happened

• For some events, you may apply up to 60 days before

Do not wait. Check now and stay covered.

Coverage Start Date

When your health coverage begins, the health plan effective date depends on the life changing event and when you selected your plan.

• Most qualifying life events: After you’ve selected a plan, coverage typically begins on the first day of the following month.

For example, if you select a plan on August 13, your coverage would begin on September 1. Enroll early to avoid gaps!

• Loss of coverage: You can apply before your current coverage ends so your new plan starts on the first of the following month after your previous coverage ends.

For example, If your previous coverage ends on Aug 13 and you select a new plan before it ends, your new coverage begins on Sept 1. There may be a mid-month gap.

• Birth, adoption, and foster care: Coverage begins on the date of the event and is applied retroactively once you enroll.

Documentation

We know paperwork is the worst. But here’s some good news: you don’t need to submit everything to window shop, compare, pick a plan, and enroll. However, these are the documents you will eventually need to provide:

• Proof of the event (e.g., job termination letter, birth paperwork, marriage certificate)

• Proof of California residency (e.g., lease, mortgage, recent utility bill, official mail)

• Proof of income (e.g., recent pay stubs, self-employment records, unemployment benefits letter, recent tax returns)

• Identity and immigration documents (if applicable)

If anything is missing, Covered California will notify you. .

Get Coverage with Covered California

Having health insurance isn’t just a good idea to safeguard both your finances and your health—in California, it is the law. Here’s how to find financial help and choose a health plan.

Coverage for Your Needs

Whether you're new to health insurance or updating your plan due to a life event, consider the following: Who needs coverage? How often do you visit the doctor? What services do you need covered?

Finding Financial Help

Covered California is the place to get financial help for plans from top health insurers. Ninety percent of people who enroll through Covered California qualify. Learn about how this works through both premium tax credits to lower the cost of your monthly premium and cost-sharing reductions that save you money when you get care.

You can get a quick estimate to find out how much financial help you might get here.

Finding Your Plan

All plans through Covered California offer the same health benefits, including emergency care, preventive and wellness services, hospitalization, and more. However, they differ in other important ways:

• Coverage level. Plans come in four tiers: Bronze, Silver, Gold, and Platinum. These tiers describe how costs are shared between you and your insurance company. With Bronze you pay less monthly and more when you get care, while Platinum is the opposite.

• Type of plan. The most common health plan types are HMO, EPO, and PPO. The difference between these plans is flexibility to see in- and out-of-network doctors and specialists.

• Provider network. If there’s a doctor you prefer, you may want to see if they are in-network with a plan before making a selection.

Learn more about what to consider when shopping for health insurance here.

Get Covered

When you need coverage, you do not have to wait. Covered California can help you find the health plan and financial help you need. At any time, you can get a quick quote to find out how much financial help you might get to pay for your health plan. Free expert help is available year-round over the phone, in person, and online.

Ready to get covered? You can start here to find a health plan that meets your needs.