When Do You Qualify for Open Enrollment for Health Insurance?


Although it’s generally easiest to apply for a healthcare plan during the regular enrollment period, often referred to as “open season”, some life circumstances allow you to enroll in best health plans in Massachusetts outside of this predetermined window. 

You may qualify for a Special Enrollment Period (SEP) if you have experienced at least one of the following life events:

1. Marriage or Divorce

When your marital status changes during the year, you are likely eligible for a Special Enrollment Period to get a new health insurance plan. This can either involve joining insurance policies with your spouse if you got married or changing to a single health plan if you got divorced. 

2. Death of a Family Member

If someone in your family that was on your health insurance policy passed away outside of the open enrollment period, you are allowed to change your health policy to discontinue coverage for the person who died. It’s important to make these changes as soon as possible to prevent yourself from paying extra premiums during a difficult time. 

3. Moving to a New State or Zip Code

In many cases, moving from one zip code to another within the same state will allow you to keep your coverage, but some insurance companies may not offer coverage in your new city. When this occurs, you will be eligible to sign up for a new plan without paying any fees or penalties. 

If you move to a new state, you will almost definitely need to enroll in new coverage, as many insurance companies are unable to provide the same policy across state lines. 

4. Birth or Adoption of a Child

Adding a new member to your family is a drastic life change, and you will need to update your health insurance policy to include your new child on your plan. Babies and children require regular checkups, and other healthcare services, that are covered by insurance that will make it much more affordable to ensure that your child remains in excellent health. 

5. Changes in Income

If your hours get cut, you get a promotion, or your small business grows, these changes in income can allow you to enroll in a different health plan outside of open enrollment. Not all changes in income will give you a SEP, but major increases or decreases in your salary can provide you with an opportunity to choose a new health plan. 

These are just a few of the several life changes that may occur throughout the year that will allow you to enroll in a new plan or make changes to your existing one outside of the regularly scheduled open enrollment window. It can be confusing and overwhelming to try to pick a healthcare plan on your own, whether inside of open enrollment or not, and many people find it helpful to enlist the help of a healthcare expert to assist them with picking a plan. 

Either way, pay close attention to your health insurance policy throughout the year and keep your plan updated when you experience major life changes. 

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