Special Enrollment Periods: Getting Health Coverage Outside Open Enrollment

Short answer: A Special Enrollment Period (SEP) lets you enroll in or change a marketplace plan outside open enrollment after a Qualifying Life Event, such as losing other coverage, moving, marriage, or having or adopting a child. In Idaho you use Your Health Idaho, and depending on the event you have 60 or 90 days to act. You may need to show documents. The monthly SEP for incomes at or below 150% of the poverty level ended for plan year 2026.

What a Special Enrollment Period Is

Marketplace health insurance has one main sign-up window each year. In Idaho, Your Health Idaho’s Open Enrollment runs October 15 to December 15. 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 a Your Health Idaho 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

Your Health Idaho lists these categories of Qualifying Life Events:

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.
Special circumstances, reviewed case by case.
An HRA offered by an employer (a health reimbursement arrangement).

The federal rules on HealthCare.gov add useful detail that generally applies across marketplaces:

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

Your Health Idaho says 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. Per HealthCare.gov, 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. Confirm your effective date with Your Health Idaho or with us 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 people whose income is low enough for Idaho Medicaid can apply for Medicaid at any time through the Idaho Department of Health and Welfare; it does not use open enrollment.

Documents to Keep

Your Health Idaho’s Special Enrollment process has two steps: submit your application and supporting documents, then choose or update your plan. HealthCare.gov also notes that documents may be required. 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 from the Idaho Department of Health and Welfare.

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

How to Use an SEP in Idaho

Note the date of your event and count forward 60 (or 90) days.
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 a Your Health Idaho plan after any tax credit.
Apply or report the change through Your Health Idaho, online or with a certified agent, and upload your documents.
Choose a plan and pay the first premium to the insurance company so coverage takes effect.

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

Just had a life change?

Call us before your window closes. We will confirm whether you qualify, help with the documents and compare the Your Health Idaho plans we represent.

Request a free comparison Call 208-350-9933

Frequently Asked Questions

How long do I have to enroll after a qualifying life event?

Generally 60 days. Your Health Idaho says that, depending on the event, you have 60 or 90 days after a Qualifying Life Event to enroll or change coverage. HealthCare.gov gives 90 days for people who lost Medicaid or CHIP coverage.

Is losing my job insurance a qualifying life event?

Yes. Losing job-based coverage, including COBRA, or aging off a parent’s plan generally qualifies. Under the federal rules you can also qualify up to 60 days before you expect to lose coverage, which helps avoid a gap. Choosing to drop coverage on your own generally does not count.

Does moving to Idaho qualify me for a Special Enrollment Period?

Moving to or within Idaho is listed by Your Health Idaho as a Qualifying Life Event. Under the federal rules on HealthCare.gov, a move generally counts when it is to a new home in a new ZIP code or county, or to the U.S. from a foreign country or territory. Moving only for medical treatment or a vacation does not count.

Can I still enroll every month if my income is low?

Not anymore. CMS ended the monthly special enrollment period for people with household income at or below 150% of the federal poverty level for plan year 2026 onward. Low-income households now need open enrollment or another Qualifying Life Event. People who may qualify for Idaho Medicaid can apply at any time.

Will I need to prove my life event?

Often, yes. Your Health Idaho asks you to report your Qualifying Life Event and provide the required supporting documents, and HealthCare.gov notes documents may be required. Keep letters showing a coverage end date, a marriage certificate, a lease or utility bill for a move, or a birth certificate.

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

Sources

Figures are labelled with the year they apply to and were checked against the official sources above on the review date. Rules and amounts change; confirm current figures with the agency that publishes them. This guide is general education, not individual advice.