If you miss the ACA Open Enrollment Period (November 1 – January 15) and don't qualify for a Special Enrollment Period (SEP), you generally cannot enroll in a Marketplace plan until the next Open Enrollment. But there are several exceptions worth checking.
The standard rule:
ACA Marketplace plans are sold during Open Enrollment, which runs:
- November 1 to January 15 (federal Marketplace + most states)
- Some state-based marketplaces have slightly extended windows (CA, NY, NJ, MA, RI extend through end of January)
- Coverage starts January 1 if you enroll by December 15; February 1 if you enroll December 16 – January 15
If you don't enroll during this window, you're typically uninsured for the rest of the calendar year unless an exception applies.
Exception 1 — Special Enrollment Period (SEP) triggers:
Many life events qualify you for an SEP outside Open Enrollment. The 60-day SEP window starts the day of the event:
- Loss of coverage: Lost employer health insurance, COBRA expired, lost Medicaid/CHIP eligibility, lost student health, lost coverage through divorce, lost coverage from a family member's death, plan exited the marketplace
- Household changes: Got married, had/adopted a baby, divorce or legal separation with loss of coverage, death in household
- Residence changes: Moved to a new ZIP/county/state (must have had qualifying coverage 60 days before the move)
- Other: Became a US citizen or lawful resident, released from incarceration, AmeriCorps service start/end, gained tribal membership
Documentation required within 30 days of enrolling. See our SEP answer for full details.
Exception 2 — Income at or below 150% FPL — year-round enrollment:
Under the Inflation Reduction Act extension (currently in effect, may expire after 2025), households at or below 150% of the Federal Poverty Level can enroll in a Marketplace plan any time of year, no SEP required.
2026 FPL thresholds at 150%:
- 1 person: $23,475
- 2 people: $31,725
- 3 people: $39,975
- 4 people: $48,225
This is a huge but underpublicized provision. Roughly 5 million Americans qualify but many never apply.
Exception 3 — Medicaid and CHIP — year-round enrollment:
Medicaid and CHIP have no enrollment periods at all. If your income qualifies (varies by state, generally ≤138% FPL in expansion states, varies in others), you can enroll any month of the year. Apply through your state Medicaid office or HealthCare.gov.
Exception 4 — American Indian or Alaska Native — monthly enrollment:
Members of federally recognized tribes can enroll in or change Marketplace plans once per month, year-round.
If none of these exceptions apply, your options are:
1. Wait for next Open Enrollment. Mark November 1 on your calendar. Coverage available January 1.
2. Short-term health insurance (with major caveats):
- Available year-round through private carriers (NOT through Marketplace)
- Premium often lower than ACA Bronze
- BUT: not ACA-compliant, so:
- Can deny coverage for pre-existing conditions
- Can exclude essential health benefits (no maternity, limited mental health, lifetime caps)
- Doesn't count as "qualifying coverage" — you'd still need to enroll in ACA at next OE
- Most plans capped at 3 months under recent federal rules; some states allow 12 months max
3. Health-sharing ministry:
- Religious cost-sharing arrangements
- NOT insurance — no guaranteed payment
- Year-round enrollment typically
- May exclude many conditions and require lifestyle agreements
4. Direct primary care + catastrophic-only coverage:
- Pay a doctor a monthly subscription for routine care ($75–$200/mo)
- Combined with a high-deductible catastrophic-style plan if available
- Doesn't cover specialists, hospitalization, or prescriptions
5. Pay out of pocket:
- Risky for serious medical events
- Can negotiate cash-pay rates with hospitals (often 30–50% less than billed)
- Use GoodRx for prescription savings
6. Move to a state with a longer Open Enrollment:
- Not realistic for most, but some state marketplaces extend OE later than federal
7. Recheck SEP eligibility:
- People often miss SEPs they actually qualify for. Examples:
- Lost coverage in October that you weren't aware of (pension changes, employer group changes)
- Adult child aged off parent's plan at 26 (often missed)
- Move to a new ZIP code (even within the same metro)
- Marriage you didn't think mattered (it does)
The high cost of being uninsured:
If you're uninsured and have a serious medical event, costs can be devastating:
- Average ER visit: $1,200–$2,500
- 1-day hospital admission: $4,000–$15,000
- Surgery: $20,000–$200,000
- Cancer treatment: $50,000–$500,000+/year
- Brand-name medications without coverage: $200–$10,000+/month
Most Americans without insurance who experience a major medical event end up in significant debt or bankruptcy. The math almost always favors getting some form of coverage.
What to do next: Call (866) 534-1886. We screen for SEP eligibility (most people qualify for one and don't realize), check 150% FPL year-round enrollment eligibility, and walk through the trade-offs of short-term plans, health-sharing, and other options if you're truly stuck. Free.