Benefits. Simplified.

The annual Open Enrollment Period is the main window each year when individuals and families can sign up for, renew, or change their health insurance plan for the coming year through the Marketplace or directly with insurers (usually November 1st through January 15th). During this time, you can enroll without needing a qualifying life event, compare plan options and prices, and update your information to make sure you’re getting all the financial help you’re eligible for. Once Open Enrollment ends, most people can only enroll or make changes if they experience a qualifying life event that triggers a Special Enrollment Period.

A Special Enrollment Period is a limited time outside the annual Open Enrollment window when you’re allowed to sign up for or change an individual health insurance plan due to certain “qualifying life events,” such as losing other coverage, moving, getting married, or having a baby. In most cases, you have about 60 days before or after the qualifying event to choose a new plan, and if you don’t enroll within that timeframe, you typically have to wait until the next Open Enrollment Period unless another qualifying event occurs.

You may qualify for a Special Enrollment Period and be able to enroll in an individual health plan if you experience a qualifying life event, such as:

• Losing other qualifying health coverage (such as an employer-sponsored plan)
• Getting married or divorced
• Having a baby, adopting a child, or placing a child for adoption
• Moving to a new permanent address
• Turning 26 and losing coverage under a parent’s plan
• A death in the family that affects your coverage
• Changes in income or household size that affect your eligibility for financial assistance
• Gaining U.S. citizenship or lawful presence
• Leaving incarceration
• Other special situations determined by the Health Insurance Marketplace

If you qualify for Medicaid or a state-based health program based on your income, your next step is to contact your home state’s Medicaid or health coverage agency directly. They can confirm your eligibility, explain what programs are available, and help you complete an application online, by phone, or in person. You can usually find the right office by visiting your state’s official website and searching for “Medicaid” or “health coverage,” or by calling your state’s main government information line and asking to be connected. Reaching out to your state ensures you get accurate, up-to-date information about benefits, provider networks, and any documents you may need to enroll.

If you qualify for Exchange/Marketplace premium tax credits, those credits are applied directly to your monthly health insurance premium to lower what you pay each month. You can usually choose to use all, some, or none of the estimated credit in advance; most people apply at least part of it to make their premiums more affordable right away. The exact amount depends on your household income, family size, and the plans available in your area, so it’s important to review plan options and check your estimated credit amount.

Our Exchange/Marketplace Platform Tool can be used for quoting and price reviews, but some states manage their own Exchange (such as Washington HealthPlanFinder for Washington residents and CoveredCalifornia for California residents). 

If you don’t qualify for Marketplace credits, you can still get comprehensive health coverage by enrolling directly with an insurance company. Buying a plan direct gives you access to the carrier’s full portfolio of options in your area, which may include networks or benefit designs that aren’t available through the Marketplace. 

COBRA or State Continuation can be helpful safety nets when maintaining continuity of care is more important than finding the lowest possible premium. It often works well for people who have ongoing treatment, complex conditions, or an upcoming surgery, because staying on the same plan means keeping the same doctors, provider networks, and prior authorizations with minimal disruption. It can also be a strong option for older adults who are not yet eligible for Medicare, since remaining in an employer group plan sometimes results in more favorable pricing and broader coverage than they might find on the individual market. At the same time, COBRA is usually more expensive because you pay the full cost of the employer plan (often plus an administrative fee), so it’s worth comparing that cost against Marketplace or direct‑to‑carrier plans, especially if you’re generally healthy or your care needs are limited.

It’s very important to be as accurate as possible when you estimate your income for Marketplace coverage because your premium tax credits are based on that estimate and are later checked against your actual income when you file your federal tax return. If your final income ends up higher than what you reported, you may have to repay some or all of the credits you received during the year; if it’s lower, you might be entitled to an additional credit. To avoid surprises at tax time, try to include all expected income sources and update your application during the year if your situation changes. For specific questions about what counts as income, and how MAGI or AGI are calculated for your household, it’s wise to talk with a qualified tax professional.