Enrollment Periods

Open enrollment periods

Open Enrollment periods for plan year 2025 vary by state:

  • In Alaska, Oregon, and Texas, open enrollment for Individual and family coverage begins November 1, 2024, and ends January 15, 2025. For applications received from November 1, 2024 through December 15, 2024, coverage will begin on January 1, 2025. For applications received December 16, 2024 through January 15, 2025, coverage will begin on February 1, 2025.
  • In Idaho, open enrollment for Individual and family coverage begins October 15, 2024, and ends December 16, 2024. Coverage will begin on January 1, 2025.
  • If you do not enroll during the Open Enrollment period dates for your location and you need coverage, you’ll have to qualify for Special Enrollment - see below.

Broker Commission

Moda Health pays a commission to appointed brokers for the work they do on your behalf. Our current commission schedule is located at modahealth.com/oregon/broker-commission


Impacted by Medicaid eligibility changes?

Medicaid redetermination is when the state checks to see if you still qualify for Medicaid. Paused during the COVID-19 pandemic, redetermination now takes place annually. If you no longer qualify for Medicaid because of a redetermination, you may find affordable coverage through a subsidized ACA Marketplace plan. Visit our Medicaid redetermination page to learn more and find your state Medicaid office.

Special Enrollment

As part of the enrollment process, you will need to provide proof of the life event that makes you eligible for Special Enrollment. In most cases you have up to 60 days from your event to apply. For events related to loss of minimum essential coverage, permanent move to a new area with new plan options, transition from a non-calendar year group plan and in some cases having an Individual Coverage Health Reimbursement Arrangement (ICHRA) or Qualified Small Employer Health Reimbursement Arrangement (QSEHRA), you can apply 60 days before or after the event.

You may be eligible for coverage in the past (also known as retroactive coverage) when:

  • You made an eligibility appeal and you were eligible based on the appeal decision
  • The process to verify your Special Enrollment request was delayed
  • Based upon qualifying for special enrollment due to certain life events

In these cases, you will receive a premium invoice to pay for coverage you can get for the past months. You can choose to pay the premium for all the months and get coverage for the past months. Or, you can pay the premiums only for the following month (also known as prospective coverage).

If you believe that you may be eligible for coverage in the past months based on one of the scenarios listed above, and would like for your premium to apply to the following month, please contact us via the phone or email listed above.


To enroll:
  1. Download the correct enrollment application for your location
  2. Locate your life event on the list below and gather the required documents
  3. Follow the instructions on the last page of the application to submit it along with the required documents

Download a 2024 enrollment application for your location

Type & Year

Application

Locations

Medical & Dental combined 2024

2024 Alaska Medical application

2024 Alaska Medical application ESP

For residents in Municipality of Anchorage, Fairbanks North Star, Haines, Kenai Peninsula, Ketchikan Gateway, Mat-Su, Petersburg and Municipality of Skagway Boroughs, City and Borough of Juneau, City and Borough of Sitka, City and Borough of Wrangell, Hoonah-Angoon Census Area and Prince of Wales-Hyder Census Area.             

Medical 2024

2024 Idaho Medical application

2024 Idaho Medical application ESP

 For residents of Ada, Adams, Bannock, Bingham, Boise, Bonneville, Canyon, Caribou, Cassia, Elmore, Fremont, Gem, Jefferson, Madison, Minidoka, Oneida, Owyhee, Payette, Power, Teton and Washington counties.

Medical & Dental combined 2024

2024 Oregon Affinity application

2024 Oregon Affinity application ESP

For residents of Baker, Crook, Deschutes, Douglas, Gilliam, Grant, Harney, Jefferson, Klamath, Lake, Lane, Malheur, Marion, Morrow, Polk, Sherman, Umatilla, Union, Wallowa and Wheeler counties. 

Medical & Dental combined 2024

2024 Oregon Beacon application

2024 Oregon Beacon application ESP

For residents of Clackamas, Clatsop, Columbia, Coos, Curry, Hood River, Jackson, Josephine, Multnomah, Tillamook, Wasco, Washington and Yamhill counties. 

Dental 2024

2024 Alaska Dental application

2024 Alaska Dental application ESP

For all Alaska residents

Dental 2024

2024 Oregon Dental application

2024 Oregon Dental application ESP

For all Oregon residents

Life events

Effective January 1, 2024:


Qualifying Life Event

New dependents What you need Coverage effective date
You have a newborn A birth certificate (Hospital, county, or government issued only) or letter from medical center showing proof of birth The date of birth of your newborn or the 1st of the month following birth upon request.  
You gained a spouse or domestic partner or you became a spouse or domestic partner (including children of a spouse or domestic partner) At least one spouse must have at least one day of minimum essential coverage in the 60 days prior to the QE, unless they lived in a foreign country or US territory for 1 or more days during that 60-day period, or if they are an American Indian/Alaska Native, or if they lived for 1 or more days during the 60 days preceding the QE (or during their most recent preceding enrollment period) in a service area where no qualified health plan was available through the Exchange. Your marriage certificate or Domestic Partnership documentation and

A document from a health insurance carrier or government healthcare program, on official letterhead or stationery, demonstrating that at least one of the spouses had minimum essential coverage within the past 60 days,

or

A letter from an employer, on official letterhead or stationery, which confirms one of the spouses had minimum essential coverage through an employer group health insurance plan within the past 60 days.

or

Documentation demonstrating at least one spouse lived for 1 or more days during the 60 days preceding the QE (or during their most recent preceding enrollment period) in a service area where no qualified health plan was available through the Exchange.

The 1st of the month following receipt of your application

You gained a dependent or became a dependent through adoption, placement for adoption or foster care

 

 

The adoption paperwork or proof of placement for adoption

or

Evidence of proof from a court or state agency that you have the legal right to make medical decisions for a child in foster care

The date of adoption or placement or the 1st of the month following adoption or placement upon request.

You have a child support order or other court order

A copy of child support order or applicable court order

The date the court order is effective or 1st of the month following court order effective date upon request.

Qualifying Life Event

Loss of coverage

What you need

Coverage effective date

Loss of minimum essential coverage

See below for required documentation for each loss of coverage event.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You lost healthcare coverage due to termination of employment
*Note: Termination due to non-payment or fraud/material misrepresentation is not a life event for special enrollment

Documentation from employer demonstrating the reason for loss of coverage including employment termination date.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You lost healthcare coverage due to divorce or termination of domestic partnership

Your divorce decree
or
Documentation from appropriate government entity demonstrating termination of domestic partnership.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You or a dependent turned 26 and are no longer eligible for the current plan

Either:
A letter from employer on business letterhead confirming loss of coverage
and
A coverage cancellation notice or Certificate of Creditable Coverage
or
A copy of letter from the carrier explaining reason for dependent cancellation.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You lost healthcare coverage due to a job-related loss of eligibility

A coverage cancellation notice or Certificate of Creditable Coverage
and
Documentation or letter from employer on business letterhead confirming the reason for loss of coverage or reduction of hours of employment to less than the number of hours required for eligibility.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You lost healthcare coverage due to Military Discharge

A Certificate of Release or Honorable Discharge from Active Duty.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Date of discharge

You lost healthcare coverage due to expiration of:

  • COBRA coverage
  • Grandfathered coverage

A coverage cancellation notice or Certificate of Creditable Coverage.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You or your dependent lost eligibility for Medicaid or CHIP

A notification of loss of Children’s Health Insurance Program or Medicaid coverage from state program.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

If you lose Medicaid/CHIP coverage you have up to 90 days to enroll in a new plan. Once your application is received, your coverage will start on the 1st of the month following month.

You lost pregnancy related coverage or lost access to health care services through coverage provided to a pregnant woman’s unborn child

A notification of loss of pregnancy related coverage from Children’s Health Insurance Program or Medicaid coverage from state program.

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application

You applied and were expected to be eligible for Medicaid or CHIP, but were ultimately determined ineligible after open enrollment ended or more than 60 days after the qualifying event

Documentation of from the US Department of Health and Human Services (HHS) on open enrollment application and transfer to Medicaid or CHIP for eligibility review
and
Documentation from Medicaid or CHIP on final ineligibility determination.

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

You lost healthcare coverage due to QHP/QDP decertification

Documentation of QHP/QDP decertification from the US Department of Health and Human Services (HHS) or other appropriate government entity.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

Your COBRA ended because you employer contribution or the government subsidies to COBRA stopped

A coverage cancellation notice or Certificate of Creditable Coverage.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1st of month following receipt of your application.

Qualifying Life Event

Others

What you need

Coverage effective date

You make a permanent move to a new area that offers different health plan options if you either had minimum essential coverage at least one day during the 60 days preceding the date of the permanent move OR you were living outside of the US or US territory at the time of the permanent move OR if you lived for 1 or more days during the 60 days preceding the QE (or during their most recent preceding enrollment period) in a service area where no qualified health plan was available through the Exchange.
*Moving solely for medical treatment or vacation is not a qualifying life event.

For school-aged children (applying solo), you will need:
A school enrollment record from the former school
and
A school enrollment record for Alaska, Idaho, Oregon or Texas.
For adult applicants & families, you will need:

From both your previous and new address, at least two of the following:

  • Utility billing statement and
  • Lease or rental agreement or
  • Mortgage statement

To demonstrate minimum essential coverage within the past 60 days:
A document from a health insurance carrier or government healthcare program, on official letterhead or stationery, demonstrating that you had minimum essential coverage within the past 60 days.
or
A letter from an employer, on official letterhead or stationery, which confirms you had minimum essential coverage through an employer group health insurance plan within the past 60 days.
If you are moving from another country, please submit a copy of your Visa or passport information page (with your photograph and personal details) and the date-stamped page.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

 

The 1st of the month following the permanent move if application is made on or before the day of the move. If application is made after the permanent move, 1st of month following receipt of your application.

You drop a dependent or choose to transition to individual coverage from a non-calendar year group plan during the group’s annual enrollment period.

Documentation from employer demonstrating the availability of the group’s annual enrollment period.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Open enrollment when you drop a dependent.
When you choose to change to individual coverage, if application is made before the end of the group’s plan year, the 1st of the month following group plan renewal date.
Otherwise, the 1st of the month following receipt of your application.

You are newly ineligible for APTC or CSR.

Documentation of APTC disqualification from the US Department of Health and Human Services (HHS).
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Effective 1st of month following receipt of your application.

You lost healthcare coverage due to QHP/QDP enrollment or disenrollment because of a HHS error or errors made by the entity providing enrollment assistance or conducting enrollment activities.

Documentation of error from the US Department of Health and Human Services (HHS)
or
Documentation of error from the entity providing enrollment assistance or conducting enrollment activities.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Appropriate date for the special enrollment circumstance, as determined by Moda

A QHP/QDP in which you enrolled substantially violated a material contract provision

Documentation of QHP/QDP material violation from the US Department of Health and Human Services (HHS)
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Appropriate date for the special enrollment circumstance, as determined by Moda

You are a victim or the dependent of a victim of domestic abuse or spousal abandonment, you are currently enrolled in minimum essential coverage, and are seeking to enroll in coverage separate from the perpetrator of abuse or abandonment.

Documentation will be determined on a case-by-case basis.

Effective 1st of the month following receipt of your application.

You are newly provided a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) through your employer.

Employer notice of QSEHRA eligibility and the QSEHRA effective date.
* If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month when QSEHRA becomes effective if application is made before the day of the life event (or if application made on the day of the life event when falling on 1st day of a month).
* If application is made on or after QSEHRA becomes effective, 1st of month following receipt of your application.
* You will only have the opportunity to apply after the life event if your employer did not provide notice of the terms of the QSEHRA at least 90 day prior to the QSEHRA effective date.

You are currently enrolled in a non-calendar year QSEHRA through your employer and lose coverage due to non-renewal of the QSEHRA at the end of the plan year.

Document demonstrating loss of coverage from your employer AND documentation from your employer demonstrating the availability of the group’s annual enrollment period.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1st of the month following the group plan renewal date if application is made on or before the end of the group’s plan year.
Otherwise, the 1st of the month following receipt of your application.

You are newly eligible for an Individual Coverage Health Reimbursement Arrangement (ICHRA) through your employer.

Employer notice of ICHRA eligibility and the ICHRA effective date.

The 1st of the month when ICHRA becomes effective if application is made before the day of the life event (or if application made on the day of the life event when falling on 1st day of a month).
* If application is made on or after ICHRA becomes effective, 1st of month following receipt of your application.
* You will only have the opportunity to apply after the life event if your employer did not provide notice of the terms of the ICHRA at least 90 days prior to the ICHRA effective date.

You are currently enrolled in a non-calendar year ICHRA through your employer and lose coverage due to non-renewal of the ICHRA at the end of the plan year.

Document demonstrating loss of coverage from your employer AND documentation from your employer demonstrating the availability of the group’s annual enrollment period.
*This life event is available for medical plans only. It is not available for dental plans.

The 1st of the month following the group plan renewal date if application is made on or before the end of the group’s plan year.
Otherwise, the 1st of the month following receipt of your application.

You did not receive timely notice of a life event that could make you eligible for special enrollment.

Document demonstrating the notice of the life event was provided to you untimely and therefore you missed the original special enrollment window.
Other documents required based on the life event listed above.

The earliest effective date that would have been available if timely notice of the life event was received.
Otherwise, the 1st of the month following receipt of your application