The low-income special enrollment period (SEP) for health insurance coverage is no longer available. This program initially allowed individuals earning up to 150% of the federal poverty level (FPL) to enroll in Marketplace insurance anytime during the year.
Background on the Low-Income SEP
In September 2021, the U.S. Department of Health and Human Services (HHS) introduced this SEP to help those who might not qualify for traditional enrollment periods. The aim was to make health insurance more accessible for low-income individuals by allowing them to sign up at any time, given they met certain income criteria and could receive tax credits.
Originally, this SEP was set to last as long as enhanced subsidizations from the American Rescue Plan were in effect. While these enhancements provide significant financial support, they will expire at the end of 2025, pending Congressional action.
In April 2024, HHS made the low-income SEP permanent. However, recent rule changes in June 2025 led to the suspension of this enrollment option for everyone from August 2025 to the end of 2026. A new law, the “One Big Beautiful Bill Act” (OBBBA), solidified this suspension, making it clear that individuals could not receive Marketplace subsidies if enrolling during an income-based SEP without a qualifying life event.
What This Means for Low-Income Applicants
Now, those who previously could enroll year-round will have to rely on the annual open enrollment period or wait for a qualifying life event to apply for coverage. This rule change impacts many, especially since the costs of unsubsidized plans could be prohibitive for those earning up to 150% of the FPL.
Even though the low-income SEP has ended, individuals can still qualify for premium and cost-sharing subsidies during the open enrollment period. It’s crucial for those affected to take advantage of this time to secure their health coverage.
Alternatives and Options
Some states still offer unique options for low-income residents:
- Oregon and Minnesota have Basic Health Programs that allow enrollment year-round for those earning up to 200% of the FPL.
- New York continues to accept applications for a program that has an income limit of 250% of the FPL, although it will revert to 200% in mid-2026.
- Massachusetts has Connector Care, which serves individuals up to 500% of the FPL with year-round enrollment for newcomers and those who haven’t been covered previously.
- Connecticut provides a program for adults earning up to 175% of the FPL.
Moving Forward
For those who can no longer access the SEP, staying informed about the annual enrollment period is essential. You can still apply for Marketplace coverage during specific qualifying life events, such as losing your current insurance. These events typically have a 60-day window for enrollment, so it’s vital to pay close attention to any changes in your situation.
As we navigate these shifts in health insurance availability, it’s crucial to understand your options and plan accordingly. Stay connected with local resources and programs to ensure you receive the coverage you need.
For more detailed guidance on health insurance and enrollment, visit Healthcare.gov.
Louise Norris has been writing about health insurance and reform since 2006 and offers insights into the complexities of the Affordable Care Act at healthinsurance.org.
