Federal, exists in every state
Find replacement health insurance (Marketplace enrollment)
A coverage loss can open a limited window to buy an individual health plan.
What it is
A coverage loss can open a limited window to buy an individual health plan.
Losing coverage can create a chance to buy an individual plan outside yearly enrollment. A diagnosis alone does not open that window. The hospital can help compare exact plan networks and costs with COBRA.
Eligibility and timing
- Ordinary qualifying coverage loss generally permits enrollment 60 days before or after the loss. Medicaid or CHIP loss permits 90 days afterward.
- When HealthCare.gov requests proof of the special-enrollment event, the usual deadline is 30 days after selecting a plan; the notice identifies the required documents and deadline.
- In 2026, federal premium tax credits generally run from 100% to 400% of poverty. Enhanced credits ended December 31, 2025.
- The income-only enrollment window at or below 150% of poverty is not available in 2026. CMS’s final 2027 rule, effective July 20, 2026, continues the prohibition beyond 2026; do not assume it reopens in January 2027. A qualifying life event or another enrollment route still needs its own check.
- Tribal members and ANCSA shareholders have special enrollment and cost-sharing routes.
- Kansas uses HealthCare.gov for 2026.
- For a qualifying loss of coverage, an assister can check the event and plan-selection window; ordinary losses generally allow 60 days before or after, while Medicaid or CHIP loss allows 90 days afterward.
- When event verification is requested, documents are generally due within 30 days after choosing a plan.
- Coverage usually starts on the first day of a month under the event’s rules, not the application date; selecting before a future loss and events such as birth can have different start rules.
- Any required first premium and verification must be completed, and delayed verification can leave premiums due for the approved retroactive start date.
What you get
- A plan that cannot exclude cancer as a pre-existing condition.
- Premium tax credits when your household meets the rules.
If you decide to apply
- If you decide to enroll, ask a Marketplace assister to check the event and coverage-loss date.
- Have ready: the loss notice, expected yearly household income, and your hospital and pharmacy names.
- Confirm the exact plan covers the treatment team and check its start date and first payment.
HealthCare.gov, 800-318-2596 · Official page ↗
Coverage start
- The insurer confirms the first premium deadline and effective date. Medicaid and CHIP applications have no yearly enrollment season.
Good to know
Voluntarily ending insurance usually does not open a window. An insurer name alone does not confirm your hospital is covered.
Official sources
“If our coverage ends, what are the benefits and drawbacks of a Marketplace plan compared with COBRA? Could you help us compare plans and decide?”
Why I’m asking: I want to avoid a treatment gap and understand the full cost.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Report the event and date inside the period, send documents within 30 days, and pay the first premium by the insurer's date.
Your social worker
Connects you to an enrollment assister and checks the exact plan against the center's contracts.
The care team
Records and letters when the application asks for them.
- Who decides
- The Marketplace (eligibility and credit) and the insurer (coverage start)
- Ask your social worker
- “Does this Marketplace plan cover our center and specialty pharmacy? Who can help compare it with COBRA before we enroll?”
How to apply
First step: Go to HealthCare.gov's special-enrollment page or call 1-800-318-2596 within 60 days of the loss (90 after Medicaid/CHIP), and report the exact event and date.
- Identify the event and its date.
- Check the treating hospital and specialty pharmacy against the exact plan.
- Compare with COBRA before choosing.
Where it starts: HealthCare.gov special-enrollment page or 1-800-318-2596. State exchanges where they exist
What to gather
- The coverage-loss notice or the Medicaid/CHIP termination letter with dates
- An annual income estimate for the tax household
- The names of the treating hospital, oncologists and the specialty pharmacy to check against the plan
How long: Enrollment is immediate once verified (30 days to send documents). Coverage starts the first of the month after you pick a plan and pay.
Clock: 60 days before or after an ordinary coverage loss to enroll.
Clock: 90 days after Medicaid or CHIP ends to enroll.
What a yes looks like
An enrollment confirmation with the premium, the credit and the start date. The hospital confirms it is in network.
What a no looks like, and the next move
“No qualifying event” or “outside the period”. Ask about COBRA or state continuation, and Medicaid, which has no season.
Watch out
- A diagnosis alone opens nothing. A lost plan, a move, a birth or a Medicaid/CHIP loss does. A Medicaid denial opens a period only on the timing branch. Keep the application and denial dates.
- Check the exact plan's network for the treating hospital and the specialty pharmacy before paying. “the hospital takes that insurer” is not enough.
- The enhanced tax credits ended December 31, 2025; higher-income families can lose all premium help. The monthly low-income enrollment period is paused through 2026.
- Members of federally recognized tribes and ANCSA shareholders have special enrollment and cost-sharing routes. Ask the Marketplace for the tribal eligibility check, the zero- or limited-cost-sharing plan, and how referrals are handled.
Dates that change this
2025-12-31: The enhanced premium tax credits ended December 31, 2025. In 2026 the credit runs from 100% to 400% of the poverty line; above 400% there is none, and repayment caps are gone.
2025-08-25: The monthly enrollment window for households at or below 150% of the poverty line is paused through plan year 2026.
2026-01-01: For tax year 2026 the below-100% exception for lawfully present immigrants is gone; from tax year 2027 the credit is limited to lawful permanent residents, Cuban/Haitian entrants and COFA migrants.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 10, 2026.
What it is worth
An ACA plan that must take a child with cancer, with a premium tax credit between 100% and 400% of the poverty line. Enrollment outside the yearly season.
Legal protection: Pre-existing-condition protection · 60-day period before or after an ordinary coverage loss · 90-day period after loss of Medicaid or CHIP · 30 days to send documents
What it costs the family: Plan-specific premium and cost-sharing. The enhanced credits ended December 31, 2025, so above 400% of the poverty line there is no credit in 2026.
The eligibility facts, as published
- Qualifying event
- yes
- Window days ordinary loss
- 60
- Window days after medicaid chip loss
- 90
- Document window days
- 30
- Medicaid denial
- opens a window only on the timing branch
Decisions this site cannot make: Event and subsidy eligibility
Expect friction on: Network and formulary checks · Enrollment timing
The trap: Check the exact plan's network for the treating hospital and the specialty pharmacy before paying. “the hospital takes that insurer” is not enough.
What changes by state: Some states run their own insurance marketplace. Federal rules set enrollment deadlines.
Where I read this
- Special Enrollment Period — HealthCare.gov, read August 27, 2026
- Special enrollment period exceptions and events — HealthCare.gov, read September 7, 2026
- Marketplace Integrity and Affordability final rule (90 FR 27074) — Centers for Medicare & Medicaid Services, read September 7, 2026
- Save on monthly premiums (premium tax credit) — HealthCare.gov, read September 7, 2026
- Public Law 119-21 (July 2025): Medicaid, CHIP, Marketplace and ABLE provisions — U.S. Government Publishing Office, read September 7, 2026