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Congratulations on your new addition! If you recently had a baby or adopted a child, you may be eligible for a Special Enrollment Period. This means you can enroll in or change your Marketplace plan even though it’s not Open Enrollment. Your new coverage can start the day of the birth or adoption, even if you enroll in the plan up to 60 days afterward.

How to apply with a Special Enrollment Period

• Create an account or log into an existing one to apply and enroll.
• Before you apply, you can preview 2020 plans and prices based on your income.

Other life changes that may qualify

• Having a baby isn’t the only life event that makes you eligible for a Special Enrollment Period. Coverage and income changes also count.
• Answer a few questions about your life event to see if you may qualify.
• You can also check out the full list of life events.

If you have Marketplace coverage and your income or household changes, update your application as soon as possible. These changes may affect the coverage or savings you’re eligible for.

Which changes to report

• Certain changes to your yearly expected income, household members, and status (like disability or tax filing status) may qualify you for a Special Enrollment Period so you can change plans outside the annual Open Enrollment Period.
• Changes may affect the savings and coverage options you qualify for, so it’s important to report them right away.
• If you don’t report changes, you could wind up getting the wrong amount of savings and owing money when you file your next tax return.

How to report changes

• Report changes to the Marketplace by updating your application.
• You can update your application online, by phone, or in person — but not by mail.
• After you finish, you may be asked to submit documents to confirm your changes.

Learn more about reporting income and household changes after you're enrolled.

Summer is a popular time for moving. Depending on whether you move to a different state, your move may impact your current health plan.

Moving to a different state

• When you move to a new state, you can’t keep your current plan.
• Report your out of state move to the Marketplace ASAP. This way, you can enroll in a new plan without a break in coverage, and you won’t pay for coverage that doesn’t apply in your new state.
• When you move out of state, you’ll need to start a new Marketplace application and enroll in a plan in your new state.
• Where to apply depends on whether your new state uses HealthCare.gov or its own website. Choose your new state to get started.

Moving within the same state

• Your coverage options and savings probably won’t change based on your new address.
• You should still update your address on your application just in case new savings and plans are available to you.
• See how to update your address online.

Learn more about reporting a move to the Marketplace.

Health coverage is important even when you don’t feel sick. No matter your health status, there are things you can do proactively to lead a healthier life.

Why are prevention and health coverage important?

• Staying healthy is important for you and your family. Taking small steps, like eating a well-balanced diet, making time for physical activity, and getting enough sleep, will improve your lifestyle at home, work, and in the community.
• Preventive services, like screenings, check-ups, and patient counseling, can help prevent illnesses, disease, and other health problems. They can also detect illness at an early stage when treatment is likely to work best.
• Ask your provider which services are most beneficial to you. Preventive services are free when delivered by a doctor or other provider in your plan’s network.

Learn more about using your coverage.

Graduation is an important milestone. As you embark on the next phase of your life, it’s also important to have health insurance to protect you from unexpected medical costs.

Why bother with health insurance

• Nobody plans to get sick or hurt, but bad things happen, even to healthy, young people. Treating a broken leg can cost $7,500, and a 3-day hospital stay can total $30,000. That’s a lot of money, especially when you’re just starting out!
• Applying for Marketplace coverage may be faster and easier than you think. With one application, you’ll find out if you’re eligible for a health plan with savings based on your income. You may qualify for free or low-cost coverage through Medicaid.
• Note: If someone claims you as a tax dependent, you can buy a plan through the Marketplace, but you won't qualify for savings based on your income.

How to get affordable health coverage

If you’re under 30, you can get health coverage a few different ways, some designed specifically for you.

• If you’re under 26, you may be able to enroll on a parent’s health insurance plan.
• You can buy your own Marketplace plan at HealthCare.gov. Depending on your situation, you may be eligible for savings based on your income.
  • If your student health plan is ending, you’re moving to a new state, or you experience other life changes, you may qualify for a Special Enrollment Period to enroll in Marketplace insurance for the rest of 2020.
  • This means you don’t have to wait until the next Open Enrollment Period this fall to apply for 2021 coverage.
  • See if you're eligible to apply right away.

Get more information on health insurance options for young adults.

It’s almost always best to get routine care and recommended preventive services from a primary care provider. There are big differences between visits to your primary care provider and emergency care.

When to see your primary care provider

• You’ll see your primary care provider both when you’re sick and when you’re well for regular care. They’ll get to know you and help track your health over time.
• You can get primary care providers in doctors’ offices, clinics, and health centers nationwide.
• Before you schedule your first appointment, contact your health plan to see how much you’ll have to pay for a primary care visit. The copayment for your visit may cost you between $0 and $50.

When to seek emergency care

• You should go to the emergency room only when you’re injured or very sick. You may wait several hours before you’re seen, and you’ll likely pay a larger copayment, co-insurance and have to meet your deductible before your health plan helps pay your costs.
• Providers in the emergency room probably won’t have access to your health records.
• Always in a life-threatening or emergency situation, call 9-1-1.

See other differences between regular and emergency care.

All Marketplace plans cover prescription drugs. Fill any prescriptions you got from your doctor and take them as directed. Here are 3 things to know about filling prescriptions:

• You may have a prescription copayment. A copayment is the amount you owe for each prescription you fill. Copayments are usually between $0 and $50, depending on your insurance plan.
• Check with your insurance company to see if you need preauthorization (also called “prior approval”). Your health plan may require preauthorization for certain drugs, unless it’s an emergency.
• Different health plans allow you to get your medications from different pharmacies (called “in-network pharmacies”). Call your insurer, or visit their website to find out which pharmacies are in their network.

Get more information on prescriptions and what to do when your drug isn’t covered.

If you applied for 2020 Marketplace coverage through a Special Enrollment Period, you may be asked to provide documents to confirm the life events that make you eligible. You must send them before you can start using your coverage.

You’ll learn if you have to provide documents after you submit your application. It’s best to pick a plan first and submit your documents afterwards. After you pick a plan, you usually have 30 days to send the documents.

Documents & deadlines for your life event

• The documents you can submit vary based on your life event.
• Select your life event for the documents you can submit and key dates.

How to submit documents

• Provide the required documents as soon as possible after you pick a plan.
• Doing so will prevent a delay in your coverage starting.
• You can submit them online or copies by mail. Follow these steps.
• After you submit them, you’ll get a letter or notice in your HealthCare.gov account within a couple of weeks saying if your Special Enrollment Period has been confirmed.

Learn more about when the Marketplace needs documents to confirm a Special Enrollment Period.

Now that you have Marketplace health coverage, learn what you can do to stay healthy and get the care you need:

Tips for staying healthy

• Make time for physical activity, healthy eating, relaxation, and sleep.
• Get the preventive services that are right for you.
• Don’t forget to schedule follow-up visits. Ask your provider to notify you in advance when recommended health screenings should occur.
• If you have questions or concerns between visits, just call your provider. It’s their job to help answer questions you have about your health.

Tips for getting proper care

• You can get health care many different places, including the emergency department. But it’s best to get routine care and recommended preventive services from a primary care provider. They’ll work with you to ensure you get the right services, manage chronic conditions, and improve your general health and well-being.
• Generally, you can find primary care providers in offices, clinics, and health centers.
• Not all types of providers and facilities take all insurance plans or types of coverage. Before you make an appointment, call the office to make sure they accept your coverage.

Read the From Coverage to Care: Roadmap to Better Care and a Healthier You (PDF, 698 KB) for tips and information on putting your health first, knowing where to go for care, and preparing for appointments.

If anyone in your household had Marketplace health insurance in 2019, you should have already received Form 1095-A, Health Insurance Marketplace Statement, in the mail. Here are 5 important things to know about this form.

Helpful tips about tax Form 1095-A:

• You should already have Form 1095-A. It comes from the Marketplace, not the IRS. If your form didn’t come by mail or you can’t find it, check your online Marketplace account before contacting the Marketplace Call Center.
• Store it in a safe space with other important tax information, like W-2 forms. This way, you can easily find it when you sit down to file.
• Before doing anything with the form, make sure it’s accurate. Check basic coverage and household member information, and confirm the premium for your second lowest cost Silver plan (SLCSP). Contact the Marketplace Call Center to report any errors.
• If you request a new, updated form, it’s important that you don’t file until we send you the correct version. If you already filed, you may need to file an amended return using the information from your new 1095-A.
• You’ll use the information from your 1095-A to “reconcile” your premium tax credit. To do this, you’ll compare the amount of premium tax credit you used in advance during the year against the premium tax credit you actually qualify for based on your final income for the year. Any difference will affect your refund or tax owed. See a step-by-step guide to “reconciling” your premium tax credit.