ACA Special Enrollment:
Complete List Of Qualifying Life Events

1. Loss of Health Coverage

You qualify for a SEP if you involuntarily lose minimum essential coverage, including:

• Loss of employer coverage due to layoff, reduced hours, or employer ending the plan
• Loss of individual or student health insurance
• Loss of Medicaid, CHIP, or Medicare eligibility
• Turning 26 and aging off a parent’s plan
• Florida specific: Young adults may stay on a parent’s plan up to age 30 if unmarried, childless, and meeting state criteria. Losing this extended dependent coverage does qualify as a QLE.
• COBRA:
• ✔ Expiration of COBRA coverage is a qualifying event
• ✘ Voluntarily dropping COBRA or failing to pay premiums is not

2. Household and Family Changes

These events qualify because they change household size or eligibility:

• Marriage
• Divorce or legal separation (in some states)
• Birth, adoption, or placement of a child
• Death of a household member
• Gaining or becoming a dependent

3. Changes in Residence

A move qualifies if it gives access to new plan options:

• Moving to a new county or ZIP code
• Moving to or from school
• Moving for seasonal or temporary work
• Moving to or from a shelter or transitional housing
• Returning to the U.S. from abroad

4. Employer Coverage Changes

You qualify for a SEP if:

• Your employer coverage becomes unaffordable under IRS rules
• Your employer coverage fails minimum value
• You gain access to an ICHRA or QSEHRA and the affordability test changes
• You lose eligibility for employer coverage
• Your employer stops offering coverage

✔ Voluntary loss of employer coverage can qualify in specific cases
You may voluntarily drop employer coverage and still qualify for a SEP if the reason is:

• The employer plan is unaffordable, or
• The plan fails minimum value, or
• You are opting out of an unaffordable ICHRA/QSEHRA

✘ Voluntary loss that does not qualify

• Dropping employer coverage simply because you prefer Marketplace coverage
• Canceling coverage mid year without a qualifying reason
• Stopping payment of premiums

5. Income Based Special Enrollment Events

Income changes qualify only when they change eligibility category.

✔ Income changes that do qualify:

• Income decreases and you become newly eligible for premium tax credits or cost sharing reductions
• Income increases and you move out of the Medicaid coverage gap (in non expansion states), making you newly eligible for Marketplace subsidies

✘ Income changes that do not qualify:

• Income changes that do not affect eligibility
• Income changes that only change the amount of subsidy
• Income changes while already enrolled in Marketplace coverage

❗ Important:

The former 100–150% FPL monthly SEP no longer exists nationwide through 2026.
Income alone no longer opens a SEP unless it changes eligibility category.

6. Changes in Citizenship or Legal Status

You qualify if you:

• Gain U.S. citizenship
• Gain lawful presence
• Are released from incarceration

7. Marketplace or Enrollment Errors

You qualify if:

• A technical error prevented enrollment
• You received incorrect information
• A navigator, broker, or assister made a documented mistake

8. Exceptional Circumstances

The Marketplace may grant a SEP for:

• Natural disasters
• Domestic violence or spousal abandonment
• Human trafficking situations
• Other hardships recognized by the Marketplace