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Frequently Asked Questions (FAQs)

Are there special circumstances that would allow me to change my plan during the year, or enroll outside of the open enrollment period?

Yes. In the Individual & Family market, certain life changes may qualify you for a special enrollment period. A special enrollment period allows you and your family to enroll in a plan, or change plans after open enrollment ends. You may qualify for a special enrollment period if you experience one of the following situations:

  • Losing qualifying comprehensive health coverage during the year, as long as you did not voluntarily terminate your health insurance or lose it because you did not pay your premiums.
  • Moving to the District of Columbia, as long as you either had qualifying comprehensive health insurance during at least 1 of the 60 days before you moved to DC, or were living overseas or in a US territory.
  • Having a baby, adopting a child, or having a child placed in your home for adoption or foster care.
  • Getting married, as long as at least one of the two spouses either had qualifying comprehensive health insurance during at least one of the 60 days before you moved to DC, or were living overseas or in a US territory.
  • Getting divorced, or legally separated.
  • Death of a household member already enrolled with you in a DC Health Link plan.
  • Entering or leaving a legally-recognized domestic partnership.
  • Becoming a US citizen or gaining legal immigration status (renewing a visa or changing visa types does not qualify).
  • Being a member of a federally recognized tribe, or their dependent, as recognized by the federal government.
  • Being court-ordered to get health coverage for yourself or someone else.
  • Being released from prison after serving a prison term.
  • Being the victim of domestic abuse or spousal abandonment, or a dependent of the victim. Gaining or losing eligibility for advance premium tax credits or cost-sharing reductions, or a change in your eligibility for cost-sharing reductions, if you are already enrolled in a DC Health Link plan.
  • You were not enrolled in coverage, enrolled in the wrong plan, or your coverage ended due to an error by a DC Health Link employee, an employee of the U.S. Department of Health and Human Services, someone providing enrollment assistance (for example, an Assister or Broker), or an insurance company representative.
  • You are enrolled in a plan that doesn’t renew at the beginning of the calendar year.
  • The insurance company offering your plan through DC Health Link (or another health insurance marketplace) violated a material provision of the insurance contract as it relates to you.
  • You were conditionally approved for Medicaid during open enrollment or a special enrollment period, but were ultimately denied (for reasons other than not providing requested documents verifying your eligibility), and received your denial notice after the open enrollment or special enrollment period expired.
  • An exceptional circumstance as defined by the DC Health Benefit Exchange Authority.

Special enrollment periods are time limited. They generally last for 60 days from the date of the event (for example, 60 days after a baby is born). A few special enrollment periods are longer. If you are moving to DC, losing health insurance, or being released from prison, you have 60 days before and after the event (a total of 120 days) to enroll. If you request the special enrollment period too late or too early, you will be denied.

To see if you qualify for a special enrollment period. Login to your DC Health Link account, or call DC Health Link at (855) 532-5465.

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