Special Enrollment Periods - Fact Sheet 21 - Eligibility and Extensions for People with Disabilities

Sep 16, 2026

Special Enrollment Periods (SEPs) can be available throughout the year for qualifying events, with special focus on people with disabilities and unique circumstances. The factsheet explains who may qualify after becoming disabled, how job loss or loss of coverage can trigger an SEP, and how income changes tied to Medicaid or marketplace assistance affect eligibility. It also covers extending signup timing when exceptional medical conditions prevent enrollment, and details the Unwinding SEP after losing Medicaid or CHIP coverage.

LanguageEnglish

CategoryForms

FormatPDF

Pages3

Reading Time1 min

AccessFree to download

Special Enrollment Periods

Introduction

Q1. Eligibility after becoming disabled

Q2. Extending an SEP enrollment window

Q3. SEP after losing Medicaid coverage (Unwinding SEP)

Q4. Documentation needed for SEP eligibility

FACT SHEET \#21 Special Enrollment Periods Introduction While Open Enrollment may be limited to a specific time in the year, individuals can potentially qualify for a special enrollment period (SEP) throughout the year. Individuals can qualify for SEPs for many reasons and there are several resources available which provide a full breakdown of these qualifying events. • For enrollment assisters: A concise reference chart from the Center on Budget and Policy Priorities describes marketplace special enrollment periods and the prior coverage requirements, effective dates, and plan switching limitations for each SEP. 1 • For current and prospective marketplace enrollees: The Centers for Medicare and Medicaid Services’(CMS) Understanding Special Enrollment Periods guide provides information on SEPs and how to access them in states that use HealthCare.gov that maybe helpful for people with disabilities.2 This factsheet provides specific information on the availability of SEPs for people with disabilities and unique circumstances that they may face. Q1. Is someone who recently became disabled eligible for a special enrollment period? No, but if the disability is accompanied by job loss or losing healthcare coverage, then yes. For example, if an individual with employer coverage experiences an accident that places them in a hospital for an extended period and in turn causes them to lose their job, they would qualify for a loss of employer coverage SEP. Cases can vary but if the outcome leads to a change in income that affects eligibility for Medicaid or marketplace financial assistance, loss or gain of dependents, or a permanent move, the individual can qualify for an SEP. Additionally, people who have an annual household income between 100-150% of the FPL are eligible for an SEP at any time (and up to one time per month), so if a new disability causes the individual’s income to drop below 150% of the FPL, they could be eligible for an SEP. Q2. Can someone get an extension of time for an SEP if a disability prevents them from signing up for coverage during the applicable 60-day or 90-day window? Yes, if a person experiences an exceptional circumstance that prevents them from accessing the SEP during the regular window, for example if the person has a serious medical condition, like an unexpected hospitalization or a temporary cognitive disability.3 This can be completed up to 60 days after they are determined eligible for an SEP. 1 [https://www.healthreformbeyondthebasics.org/sep-reference-chart/](https://www.healthreformbeyondthebasics.org/sep-reference-chart/) 2 [https://www.cms.gov/marketplace/outreach-and-education/special-enrollment-periods-available-to](https://www.cms.gov/marketplace/outreach-and-education/special-enrollment-periods-available-to)consumers.pdf 3 [https://www.healthcare.gov/sep-list/](https://www.healthcare.gov/sep-list/) Q3. Is a person who recently lost their Medicaid coverage eligible for a special enrollment period? Yes, losing Medicaid coverage outside of the open enrollment period can qualify someone for a special enrollment period, also known as the “Unwinding SEP.” This SEP allows individuals in states with Marketplaces served by the HealthCare.gov platform to enroll in Marketplace coverage. Marketplace-eligible consumers who submit a new application or update an existing HealthCare.gov application between March 31, 2023, and November 30, 2024, and attest that they have lost Medicaid or CHIP coverage in the same time period are eligible for the Unwinding SEP. These individuals then have 60 days after they receive their eligibility determination to select a plan with coverage that will start on the first day of the month after they select a plan. Individuals will not be required to submit documentation to verify loss of Medicaid or CHIP to qualify for the Unwinding SEP. Note that after the Unwinding SEP expires, loss of Medicaid or CHIP still triggers a 90-day SEP. Q4.

FAQs

Is someone who recently became disabled eligible for a special enrollment period?

Not solely because of disability. Eligibility can apply when disability is paired with job loss or loss of healthcare coverage, or when income drops between 100–150% of the FPL, subject to SEP limits.

Can a person extend the time to sign up for an SEP if a disability prevents enrollment in the usual 60- or 90-day window?

Yes, if an exceptional circumstance blocks access to the SEP during the regular window, such as unexpected hospitalization or temporary cognitive disability. Enrollment can be completed up to 60 days after eligibility is determined.

What is the Unwinding SEP after losing Medicaid coverage, and who qualifies?

Losing Medicaid coverage outside open enrollment can qualify for the Unwinding SEP. For eligible states using HealthCare.gov, marketplace enrollees can apply or update between March 31, 2023 and November 30, 2024, attest to losing Medicaid or CHIP, and then choose a plan within 60 days after the eligibility determination.

What documentation may be required to qualify for an SEP when a marketplace requests verification?

A marketplace eligibility notice provides details and instructions, and documentation is typically due within 30 days. Proof may include letters showing the end of coverage, employer benefit drops, program determinations of ineligibility, loss of student health coverage, or an explanatory letter if documents are not readily available.

Sep 16, 2026

Uploaded by Riley West