Health insurance guide
Special Enrollment Periods: Who Qualifies
A Special Enrollment Period lets you buy marketplace coverage outside Open Enrollment after a qualifying life event. The rules tightened recently: the monthly low-income SEP has ended, and income-based enrollment no longer comes with subsidies. Here is who qualifies and how long you have.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
Request health insurance quotes
Tell us what you would like to cover, and a licensed agent will follow up with options available to us. Submitting the form does not bind coverage.
Turning 65 or already on Medicare? Request Medicare plan quotes with our Medicare quote form.
If the form does not load, call 888-387-3687, Monday through Friday, 9:00 to 5:00, or email info@blakeinsurancegroup.com.
Common qualifying life events
- Losing other health coverage, such as job-based coverage or Medicaid.
- Moving to a new ZIP code or county.
- Getting married.
- Having a baby or adopting a child.
- Other events listed by HealthCare.gov or your state marketplace.
Outside Open Enrollment, you need a Special Enrollment Period, usually triggered by a life event such as losing other coverage, moving, marriage, or having a baby, and generally lasting 60 days. The monthly low-income Special Enrollment Period that let people under 150% of the poverty level enroll any time has ended, and since 2026 people who enroll through an income-based SEP not tied to a life event can’t get premium subsidies.
Keep documents that prove the event, such as a letter showing when other coverage ended, since marketplaces may ask for proof.
Medicare Special Enrollment Periods
Medicare has its own Special Enrollment Periods, for example when you lose employer coverage or move out of your plan’s area. Use our Medicare quote form if you’re 65 or older.
Premium tax credits after 2025
The enhanced premium tax credits that lowered marketplace premiums from 2021 through 2025 expired on December 31, 2025. The House passed a three-year extension in January 2026, but the Senate didn’t, and no extension had been enacted as of October 2026. That means the original rules apply again: premium tax credits are generally available from 100% to 400% of the federal poverty level, and households above 400%, about $63,840 for a single person for 2027 coverage, get no credit at all.
KFF had estimated that subsidized enrollees’ average premium payments would more than double, from $888 in 2025 to $1,904 in 2026, if the enhancements expired. For 2027 coverage, the IRS caps the benchmark silver premium for eligible households at between 2.15% and 10.22% of income, depending on income.
| Household size | 100% of poverty | 400% of poverty |
|---|---|---|
| 1 | $15,960 | $63,840 |
| 2 | $21,640 | $86,560 |
| 3 | $27,320 | $109,280 |
| 4 | $33,000 | $132,000 |
48 states and DC. Source: HHS poverty guidelines (Federal Register, Jan. 15, 2026); 400% figures computed. Alaska and Hawaii are higher.
When you can enroll
Open Enrollment for 2027 coverage on HealthCare.gov runs November 1, 2026 through January 15, 2027, and you generally need to enroll by December 15 for coverage starting January 1. A 2025 federal rule would have ended enrollment December 15, but a federal court vacated that change in June 2026; HHS has appealed, so check HealthCare.gov or your state marketplace for the latest dates. Some state marketplaces set their own deadlines: California and New York run through January 31, 2027, and Virginia through January 29.
Outside Open Enrollment, you need a Special Enrollment Period, usually triggered by a life event such as losing other coverage, moving, marriage, or having a baby, and generally lasting 60 days. The monthly low-income Special Enrollment Period that let people under 150% of the poverty level enroll any time has ended, and since 2026 people who enroll through an income-based SEP not tied to a life event can’t get premium subsidies.
Plan levels and cost limits
Marketplace plans are grouped into metal levels, bronze, silver, gold, and platinum, by how costs are shared between you and the plan. Bronze plans have the lowest premiums and highest out-of-pocket costs; gold and platinum the reverse. Silver plans matter for subsidies: the premium tax credit is based on the second-lowest-cost silver plan in your area, and people with lower incomes can get extra cost-sharing reductions only on silver plans.
Marketplace plans cap in-network out-of-pocket costs for essential health benefits. The federal maximum is $10,600 for an individual and $21,200 for a family in 2026, rising to $12,000 and $24,000 for 2027, according to CMS.
Premium trends
Premiums rose sharply for 2026: KFF reports the average benchmark premium for a 40-year-old climbed about 26%, from $497 to $625 a month. Even so, 22.97 million people selected marketplace plans during 2026 Open Enrollment, according to CMS. Preliminary 2027 rate filings averaged a 15.9% increase, according to a September 2026 analysis by Manatt.
Short-term plans
Short-term health plans aren’t ACA plans: they can exclude pre-existing conditions and don’t have to cover all essential benefits. A 2024 federal rule limits them to three months, or four with renewals, but federal agencies said in August 2025 they won’t prioritize enforcing that rule until new rules are issued, and states can set their own limits. Check your state’s rules before buying one.
Turning 65
If you’re turning 65, you’ll generally move from marketplace coverage to Medicare. Medicare has its own enrollment periods, and keeping a marketplace plan after you become eligible for premium-free Part A usually means losing any premium tax credit. Our Medicare quote form, linked near the top of this page, is the place to start.
Reporting income and tax-time reconciliation
Premium tax credits are based on your estimated income and reconciled on your federal tax return, so report income and household changes to the marketplace during the year. If you received more credit than you qualified for, you may owe some back at tax time. CMS told marketplaces in July 2026 to stop removing credits for failure to file and reconcile for the 2026 and 2027 plan years, according to the Kansas Health Institute, but you still need to file to reconcile.
Checking a plan and insurer
- Network. Confirm your doctors and hospitals are in network.
- Drugs. Check your prescriptions on the plan’s formulary.
- Total cost. Compare premiums, deductibles, and the out-of-pocket maximum.
- Subsidy. Make sure the price reflects any premium tax credit you qualify for.
- Agent license. Confirm the agent is licensed in your state.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- ASTHO: Enhanced premium tax credit developments (Jan. 2026)
- HealthCare Insider: Will you qualify for an ACA subsidy in 2027? (Oct. 2026)
- KFF: Marketplace premium payments if enhanced credits expire
- IRS Rev. Proc. 2026-26: 2027 applicable percentages
- Federal Register: 2026 HHS poverty guidelines (Jan. 15, 2026)
- healthinsurance.org: When is the next open enrollment period? (Oct. 2026)
- HealthCare Insider: Marketplace deadlines for 2027 coverage (Sept. 2026)
- The Kory Agency: 2027 ACA open enrollment date changes (Sept. 2026)
- Becker's Payer: HHS appeals decision vacating 2025 marketplace rule provisions
- healthinsurance.org: What happened to the low-income SEP? (May 2026)
- Kansas Health Institute: What's changing on the ACA marketplace (Aug. 2026)
- CMS: 2027 premium adjustment and cost-sharing parameters (Jan. 2026)
- U.S. Department of Labor: Short-term limited-duration insurance statement (Aug. 2025)
- KFF: Marketplace average benchmark premiums by state
- KFF: Marketplace insurers by state
- KFF: Status of state Medicaid expansion (Oct. 2026)
- CMS: Marketplace 2026 Open Enrollment report (Jan. 2026)
- Manatt: Preliminary 2027 ACA rates (Sept. 2026)
- healthinsurance.org: What type of exchange does my state have? (Sept. 2026)
What to have ready for a health insurance quote
These details help an agent quote accurately.
- Household. Everyone in your tax household and their dates of birth.
- Income. Your expected 2027 household income.
- Doctors and drugs. Providers and prescriptions you want covered.
- Current coverage. Any job-based, Medicaid, or other coverage offers.
- ZIP code. Plans and prices vary by county.
Special Enrollment Periods FAQs
How long is a Special Enrollment Period?
Generally 60 days after the qualifying event.
Can I enroll any time if my income is low?
No longer. The monthly low-income SEP has ended, and income-based SEPs don’t come with subsidies.
Does moving qualify me?
Moving to a new area where different plans are available usually qualifies.
Does losing a job qualify me?
Losing job-based coverage is a common qualifying event.
Related guides
Important information
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Health insurance figures. Subsidy rules, enrollment dates, and premiums on this page were checked against the listed sources in October 2026 and can change. Confirm with HealthCare.gov or your state marketplace.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a quote, and a licensed agent will compare options available to us for your situation.
