You may be eligible to enroll in a new health plan outside of open enrollment if you experience certain life changes. Here are some of the qualifying events applicable in New York and Vermont.
This is your chance to add your new spouse to your plan. Even if you both already have coverage, you may want to explore your options as newlyweds. Together, you may qualify for financial assistance (based on income) if you apply for a plan in New York on NY State of Health™: The Official Health Plan Marketplace or through the Vermont Marketplace, Vermont Health Connect.
When you welcome a child into your family by birth or adoption, you have the opportunity to add the child to your health plan. Based on your income and family size, your family may also be eligible for financial assistance in a Marketplace plan.
If you move outside the service area of your current health plan, you may be eligible to get a new health plan that is closer to home. You may also qualify for a Special Enrollment Period in Vermont if you have moved to Vermont from another state.
If you lost your job-based coverage for any reason (including quitting your job or changing to a part-time position), you may qualify for a special enrollment period.
Your 26th birthday
When you turn 26 or “age off” a parent’s plan (meaning you are no longer eligible for coverage as a dependent), you can enroll in your own plan so you don’t have a gap in coverage.
If you are enrolled in a Marketplace plan in New York or an Exchange plan in Vermont, a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions may allow you to make changes to your health plan.
Loss of coverage due to a divorce, COBRA expiration, loss of eligibility for Medicaid, New York’s Child Health Plus, Vermont’s Dr. Dynasaur, or other, more complex circumstances could allow you to qualify for a Special Enrollment Period. Note: Voluntarily ending coverage or losing coverage that doesn’t qualify as minimum essential coverage DOES NOT qualify you for a special enrollment period. If you lose coverage because your premiums are not paid on a timely basis, you will need to wait until the next open enrollment period to re-enroll.