The 60-Day Rule
Health insurance in the U.S. runs on a calendar. Open Enrollment happens once a year — for Texas ACA plans, roughly November 1 to January 15. Outside that window, you generally can't buy or change ACA-compliant coverage without a qualifying life event that unlocks a Special Enrollment Period.
Qualifying Life Events
| Event | SEP window | Typical documentation |
|---|---|---|
| Loss of job-based coverage | 60 days before or after | Termination letter, HR notice, COBRA offer |
| Marriage | 60 days after | Marriage certificate |
| Birth or adoption | 60 days after | Birth certificate, adoption papers |
| Divorce (if losing coverage) | 60 days after | Divorce decree, coverage loss letter |
| Move to new coverage area | 60 days after | Lease, utility bill, driver's license |
| Aging off parent's plan at 26 | 60 days before or after | Prior coverage certificate |
| Gain/lose Medicaid or CHIP | 60 days after | Termination or determination notice |
How to Enroll Using a SEP
- Note the date of the event. That starts the 60-day clock.
- Gather documentation (letter, certificate, lease).
- Apply through the Marketplace or an authorized broker and select the SEP reason.
- Upload documentation when requested — coverage isn't final until verified.
- Choose an effective date. Coverage often starts the first of the following month.
Common SEP Mistakes
What If You Don't Qualify?
Not everyone has a qualifying event, and the ACA Marketplace won't help mid-year without one. You still have options:
- Private PPO plans — available year-round for those who medically qualify.
- Short-term medical — non-ACA gap coverage; useful for a few months but limited on pre-existing conditions.
- Employer coverage (if newly available).
- Medicaid or CHIP — no enrollment period if you qualify by income.
Read the Marketplace vs Private PPO comparison to see which path fits your situation.
Frequently Asked Questions
A Special Enrollment Period (SEP) is a 60-day window (usually) to enroll in ACA-compliant coverage outside the annual Open Enrollment Period. SEPs open after a qualifying life event.
Losing job-based coverage, getting married or divorced, having or adopting a baby, moving to a new coverage area, turning 26 and aging off a parent's plan, becoming a U.S. citizen, or gaining/losing Medicaid eligibility, among others.
Most SEPs last 60 days from the date of the qualifying event. Some — like losing job coverage — can start up to 60 days before the event.
The Marketplace typically asks for a document proving the event: a termination letter, marriage certificate, birth certificate, lease showing the new address, or a coverage-loss letter.
Generally no on the ACA Marketplace. But private off-Marketplace PPO plans and short-term coverage can be purchased year-round without a qualifying event.
You may need to wait until the next Open Enrollment for ACA-compliant coverage. In the meantime, private year-round PPO plans, short-term medical, or gap coverage can bridge you.
