Can You Get Health Insurance After Open Enrollment Ends?

1. Your five mid-year enrollment paths

Once Open Enrollment closes, the ACA Marketplace becomes restricted — but coverage is still very much available if you understand the routes. Here’s the complete map:

The first option — SEP via qualifying event — is the one most people overlook. The next sections walk through each path in detail.

2. Special Enrollment Period qualifying events

A Special Enrollment Period gives you a 60-day window to enroll in ACA Marketplace coverage after a qualifying life event. Each event has a specific definition and documentation requirement.

Loss of qualifying coverage

• Job loss (laid off, fired, quit) — loss of employer-sponsored coverage
• Loss of COBRA when your maximum coverage period ends (typically 18 months)
• Aging off a parent’s plan at age 26
• Spouse loses job and you were a dependent on their plan
• Reduction in work hours below your employer’s benefits threshold
• Loss of Medicaid or CHIP (e.g., redetermination found you ineligible)
• Death of a policyholder you were covered under
• Divorce or legal separation that ends your coverage as a dependent

Changes in household composition

• Marriage — one spouse must have had qualifying coverage in the prior 60 days
• Birth or adoption of a child — coverage retroactive to date of birth/placement
• Divorce if it results in loss of coverage
• Death of a household member

Changes in residence

• Permanent move to a new ZIP code where different plans are available
• Move to/from a shelter or transitional housing
• Seasonal workers moving for the season
• Students moving to or from school
• Release from incarceration

Other qualifying changes

• Becoming a U.S. citizen or gaining lawful immigration status
• Membership in a federally recognized tribe (year-round enrollment, monthly opportunities)
• Income change that makes you newly eligible for or ineligible for subsidies (in some cases)
• Marketplace error or misconduct that prevented prior enrollment
• Exceptional circumstances (natural disaster, serious medical condition, etc.)

3. How to apply during an SEP

Once you have a qualifying event, the process is:

1. Confirm your event date. The 60-day clock starts on the date of the qualifying event (or the date of coverage loss, for loss-of-coverage events).
2. Go to Healthcare.gov (or your state Marketplace) and start a new application. Select “I had a life change recently” when prompted.
3. Choose your event type from the dropdown. The application will adjust the questions based on your event.
4. Submit documentation proving the event — termination letter, marriage certificate, birth certificate, lease, etc. The Marketplace verifies most events before activating coverage.
5. Compare plans and enroll. Pick a plan within your Special Enrollment Period, and upload any documents the Marketplace asks for by the deadline it gives you.
6. Coverage start date depends on event type: most SEPs follow the “1st of the next month” rule; birth, adoption and foster-care SEPs can start on the day of the event; and for loss of coverage, if you pick a plan before your old coverage ends, the new plan starts the first day of the month after it ends (otherwise, the first day of the month after you pick a plan).

4. Medicaid: year-round enrollment

Medicaid has no enrollment window. If your income drops below your state’s threshold — or you experience a life change that newly qualifies you — you can apply any day of the year. Coverage typically starts the 1st of the month you apply. Medicaid can also cover some medical bills from before you applied: up to 3 months back today, but for applications made on or after January 1, 2027, that drops to 1 month for expansion adults and 2 months for most others.

2026 Medicaid eligibility (expansion states)

In the 40 states plus DC (41 in all) that have expanded Medicaid under the ACA, the threshold is 138% of the Federal Poverty Level:

• Single: about $22,025/year (about $1,835/month)
• Family of 2: about $29,863/year
• Family of 3: about $37,702/year
• Family of 4: about $45,540/year

These figures use the 2026 HHS poverty guidelines for the 48 contiguous states and DC (Alaska and Hawaii are higher), and they will change when the 2027 guidelines take effect.

Non-expansion states (10 as of 2026)

TX, FL, GA, TN, MS, AL, SC, KS, WY and WI have not expanded (KFF, August 2026). In these states, Medicaid is restricted to specific populations (parents of minor kids, pregnant women, people with disabilities, seniors). Adults who don’t fit those groups and earn below 100% of FPL (about $15,960 for one person for 2027 coverage) can fall into the “coverage gap” — too little income for ACA tax credits, but not eligible for Medicaid. Georgia and Wisconsin cover adults up to 100% of FPL through waivers, so KFF says no gap exists there. There’s no easy fix for the gap; your best options are short-term medical or waiting for next OEP.

5. Short-term medical as bridge coverage

Short-term medical (STM) plans are non-ACA insurance products designed to fill gaps between major coverage. Where state law allows them, you can apply any time of year, and the start date depends on the plan (often sooner than a Marketplace plan can start).

When STM is useful after missed OEP

• You’re young, healthy, and need catastrophic coverage
• You expect to qualify for an SEP soon (waiting for a marriage, a move, etc.)
• You missed OEP and the next one isn’t until November
• You need coverage sooner than a Marketplace plan can start (check the plan’s start date)

STM limitations to understand

• Pre-existing conditions excluded — STM is medically underwritten. Conditions you’ve been diagnosed with or treated for during the plan’s look-back period are typically not covered.
• No essential health benefits requirement — maternity care, mental health, prescription drugs may be limited.
• Plan duration varies by state — how long you can keep a plan depends on your state and the plan, from 3 months or less in some states to longer terms with renewals where state law allows, and some states do not allow short-term plans at all.
• Not minimum essential coverage, which matters in states with their own coverage mandates and penalties (such as California, Massachusetts, New Jersey, Rhode Island and DC).
• Lifetime caps and per-illness maximums can leave you exposed on a major claim.

Cost typically $80–$300/month depending on age, health, and state. More on short-term medical →

6. Private PPO plans outside Open Enrollment

Beyond the ACA Marketplace, some private health plans are sold outside Open Enrollment. The private PPO and EPO plans FreedInsure offers use the Cigna PPO network; they are not insured by Cigna. You can apply for them outside Open Enrollment, but approval depends on each plan’s eligibility rules and underwriting, and the start date depends on the plan. They are not Marketplace plans, so a premium tax credit can’t be used on them.

When a private plan can make sense

• No tax credit: your household income is above 400% of FPL (about $63,840 for one person or $132,000 for a family of four for 2027 coverage), so you’d pay full price for an ACA plan
• Healthy, with predictable use: no ongoing specialist care, generic drugs only, no planned surgery or pregnancy
• Network preference: you want a plan that uses the Cigna PPO network, and you’ve confirmed your doctors are in it
• Timing: you missed Open Enrollment, have no Special Enrollment Period, and want to ask whether a private plan can bridge you to the next Open Enrollment

When an ACA plan is the better call

• You likely qualify for a premium tax credit (100%–400% of FPL) or Medicaid
• You have a pre-existing condition or ongoing treatment: all Marketplace plans must cover pre-existing conditions. Ask us to confirm in writing how any private plan handles them.
• You’re pregnant or planning to be
• You take expensive brand-name or specialty drugs
• You want a firm out-of-pocket ceiling: $12,000 for one person on ACA plans in 2027

A “PPO” label doesn’t guarantee out-of-network coverage. Some plans that use a PPO network cover in-network care only, except emergencies, and PPO plans with out-of-network benefits typically charge more out of network. Ask for the plan’s Summary of Benefits and Coverage before you enroll.

The Cigna PPO network is a provider network; Cigna is not the insurer of these plans and doesn’t pay their claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.

These plans are not sold through the ACA Health Insurance Marketplace (HealthCare.gov or your state’s exchange) and are not individual-market ACA plans. You can’t use a premium tax credit or cost-sharing reduction to pay for them. As HealthCare.gov puts it, “the only way to get the premium tax credit is through the Marketplace.”

Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan’s own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.

FreedInsure LLC is an independent insurance agency; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 jurisdictions (41 states + DC). Our help is free to you, and we’ll show you your ACA Marketplace options (in the states where we sell them), including any tax credit you qualify for, next to any private plan.

7. What you CAN’T do after Open Enrollment

Some myths to clear up about post-OEP enrollment:

You can’t enroll in ACA Marketplace without an SEP or Medicaid eligibility

Even if you’re willing to pay full price (no subsidies), the standard ACA application is closed outside OEP and SEP windows. There’s no “open application for full-price ACA” option. This isn’t a financial barrier — it’s a regulatory one.

You can’t use STM as a permanent replacement

STM is structured for short-term coverage by design. Continuous STM enrollment year after year leaves you exposed: pre-existing conditions accumulate, lifetime caps apply, and any major diagnosis will likely be excluded from subsequent renewals.

You can’t backdate enrollment beyond the rules

Even with an SEP, coverage start dates follow specific rules. Most SEPs activate coverage on the 1st of the month after enrollment, not retroactively. Exceptions: birth, adoption and foster care (coverage can start on the day of the event), and loss of coverage when you pick a plan before your old coverage ends (the new plan starts the first of the month after it ends, so there’s no gap). You can’t just say “make my coverage start March 1st” if you’re enrolling in May.

“No penalty” doesn’t mean “no enrollment rules”

The federal individual mandate penalty was reduced to $0 in 2019, but enrollment rules still exist. Several states (California, Massachusetts, New Jersey and Rhode Island) and DC have their own mandates with penalties. And the federal rules around when you can enroll didn’t change — only the tax penalty for being uninsured.

8. Strategic timing for the rest of the year

If you missed OEP and have no SEP today

Three plays:

1. Check Medicaid eligibility right now. A surprising number of people qualify and don’t realize it. No window, no waiting.
2. STM as bridge coverage. Buy temporary catastrophic protection while you wait for next OEP or watch for an SEP; how long you can keep a plan depends on your state and the plan.
3. Mark your calendar for November 1, 2026. Next OEP opens for 2027 coverage. Enroll by Dec 15 for January 1 coverage; by Jan 15 for February 1 coverage.

If you’re approaching an SEP-triggering event

If you expect to lose qualifying coverage (for example, your job-based plan is ending), you can apply up to 60 days BEFORE the loss, so your new plan starts the first day of the month after your old coverage ends. For a marriage, a birth or an adoption, you have 60 days after the event to pick a plan, and a new baby’s coverage can start on the day of birth.

If you’ve had a life event in the past 60 days and didn’t act

Apply immediately. The 60-day SEP window is strict — once it closes, you’re back to the no-window state until next OEP.

Sources

• HealthCare.gov: Special Enrollment Period — 60 days before or after losing coverage; 90 days after losing Medicaid or CHIP; birth and adoption coverage from the day of the event
• HealthCare.gov: Confirming your Special Enrollment Period — when coverage starts after a loss of coverage
• HealthCare.gov: Dates and deadlines — Open Enrollment for 2027 coverage, November 1, 2026 to January 15, 2027
• Medicaid.gov: CMCS Informational Bulletin, Nov. 18, 2025 (PDF) — shorter retroactive coverage for applications on or after January 1, 2027
• HHS ASPE: Poverty guidelines — 2026 guidelines used for the 138% FPL figures
• KFF: Status of state Medicaid expansion decisions — 41 expansion states including DC; 10 non-expansion states
• KFF: The Medicaid coverage gap — no coverage gap in Georgia and Wisconsin
• NY State of Health and Get Covered New Jersey — 2027 Open Enrollment through January 31, 2027