Special enrollment: When life changes, your health plan can, too

You may qualify for a special enrollment period when life happens

Jobs change. Couples get married. Babies arrive. People move to new states. When life happens, your health insurance needs can change, too—sometimes without warning.

We make a big deal about making sure you sign up for a health plan during Open Enrollment, which usually starts Nov. 1, because we don’t want you to miss out. But if your circumstances change because of a life event, we may still be able to help if you qualify to get coverage through a Special Enrollment Period, or SEP.

How to qualify

You have to follow some federal and state rules to get health insurance when it’s not Open Enrollment season. You generally have 60 days from the date of a qualifying event to enroll. Here are a few criteria:

• Lost coverage, such as losing or quitting a job, an expiring COBRA subsidy, losing MaineCare or other government coverage, or turning 26 and dropping from a parent's plan.
• Changes in your family, such as getting married or forming a domestic partnership, having or adopting a baby, fostering a child, becoming a U.S. citizen or gaining legal immigration status. Maine is also one of the few states that allow you to sign up if you become pregnant.
• Moved to Maine: More than 7,400 people moved to Maine in 2025. If you're among those moving to the Pine Tree State and need health coverage, you can get a health plan with proof of your old and new addresses.

SEPs exclude people who asked for coverage to end, stopped paying or lost coverage from late premium payments. And importantly, Congress ended the low-income SEP option for 2026, so those at or below 150% of the federal poverty level now need a qualifying event or have to wait for Open Enrollment.

You can find a full list of criteria here, on the website for Maine’s marketplace, CoverME.gov.

Note: Members of a federally recognized tribe or an Alaskan Native Claims Settlement Act (ANCSA) Corporation shareholder can enroll at any time. 

How to apply

Maine recently introduced a new process

First, you can no longer apply online for an SEP by yourself through CoverME.gov, effective for plans beginning March 6. Instead, get started by calling the state’s Consumer Assistance Center (CAC) at (866) 636-0355. They’ll initially qualify you and open the enrollment portal so your broker can help get you choose a plan and sign up. You can also schedule a call with a Community Health Options advisor.

Second, you may be asked to send documents that verify you’re eligible for coverage, especially for loss of coverage or becoming a new Maine resident. You’ll need to send these in before you can begin using coverage. Here are some examples of documents accepted as forms of proof: 

• Loss of coverage: Health insurance termination letter or a letter from an employer.
• Maine residency: Lease or mortgage statement, Maine driver's license, or something like a utility or internet bill, or U.S. Postal Service change of address confirm letter.
• Marriage or domestic partnership, family changes: Licenses or related documents, birth or adoption certificates.
• U.S. citizenship: U.S. passport, certificates of naturalization or citizenship, or a birth certificate or photo ID.

For brokers

Remember, beginning March 6, CoverME.gov no longer offers online self-service for SEPs. Your clients will need to first call the CAC, where someone will qualify them and open the portal so you can help in finding and enrolling them in a health plan.

There are more steps added to your workflow for an off-marketplace plan, and Community Health Options can help make the process as smooth as possible for your clients. A few tips:

• Get ahead of the paperwork: Encourage clients to collect their documents before they start the SEP process. That will speed things up.
• Download the enrollment form: Complete the Community Health Options individual enrollment form. You'll need to fill out all the information and attach this in the portal.
• Give your client your email: Ensure the Member can email you the documentation to prove their SEP life event so you can upload it to the portal.
• Call your account manager for help: We're here to help, so don't hesitate to call your account manager, including for help finding the enrollment form or uploading your client's documents.

Have a question about your health plan and what's covered? Call our Maine-based Member Services team at (855) 624-6463 from 8 a.m. to 5 p.m., Monday through Friday. Interested in learning whether you qualify for an SEP and want to know more about our plans? Schedule a call here. 

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