You may think that health insurance is only available to folks in Central Oregon during the annual open enrollment window in the fall. But that’s not always the case. Major life changes—like moving to Bend or Redmond, losing job-based coverage, or welcoming a new baby—can potentially qualify you for a Special Enrollment Period (SEP).
A SEP gives you a window (usually 60 days) to enroll in a new health plan or switch to one that better fits your life in Central Oregon. Acting quickly helps you avoid coverage disruptions, lock in the right subsidies, and make sure you continue to have coverage available when you need it.
👉 Not sure if you qualify? Schedule a free coverage review today.
What are Special Enrollment Periods?
A SEP is a limited window of time when you can make changes to individual health coverage outside of the regular open enrollment period. Depending on your specific qualifying event that triggers your SEP, you may be able to enroll in an individual health insurance plan or change your existing plan. Depending on the type of SEP you qualify for, this window is typically 60 days before or after your qualifying event.
SEPs are designed to help people who experience major life changes that affect their health coverage. For example, if you move to Central Oregon or lose coverage from an employer, you may qualify for a SEP. During this time, you can:
- Enroll in a new Marketplace plan that includes local Central Oregon providers.
- Update your plan so you receive the correct premium tax credits for your new household income or location.
- Avoid getting stuck on a plan that doesn’t cover Bend, Redmond, or other Central Oregon healthcare networks.
SEPs make it possible to help ensure you have adequate coverage—even when life circumstances shift.
Common qualifying life events for a Special Enrollment Period
You don’t have to wait for open enrollment if you experience certain life changes. There are a number of qualifying life events—each of which can trigger a 60-day SEP. Here are the most relevant ones for most folks in Central Oregon:
Moving to Central Oregon
Relocating to a different ZIP code or county—like moving from another state to Bend, Redmond, or Sisters—could open up SEP eligibility. Generally, you can qualify if you move out of your current plan’s service area. Temporary moves (like vacations or for medical treatment) don’t count.
Losing coverage
You may qualify if you lose health insurance—from your job, a parent’s plan, or due to income changes that end eligibility for Medicaid or CHIP. Even losing coverage because your plan is discontinued or you’ve moved out of its service area could qualify.
Changes in your household
Life events like marriage, divorce (with loss of coverage), birth or adoption of a child, or the death of a covered family member may all trigger a SEP.
Other events that count
These can include becoming a U.S. citizen, being released from jail or prison, or being affected by a natural disaster (e.g., local flooding or fires). SEPs may also apply if you start or end service with AmeriCorps or gain membership in a federally recognized tribe.
What happens if you miss your SEP window?
Special Enrollment Periods are time-sensitive, so you don’t want to drag your feet. If you miss this window, you may have to wait until the next open enrollment period (which begins on November 1st) to make changes or enroll in a new plan.
Missing your window could mean:
- Being locked into an old plan that doesn’t cover Bend, Redmond, or other Central Oregon providers.
- Paying higher out-of-pocket costs if your old plan treats local doctors and clinics as out-of-network.
- Losing eligibility for premium tax credits.
- Going uninsured.
Missing the 60-day window doesn’t mean you’re left without any options—alternatives like medical cost-sharing programs could still provide affordable protection. But the safest route is to act promptly when a qualifying life event occurs so you have time to explore all your options and don’t end up with an unexpected gap in coverage.
Alternatives beyond marketplace plans
While marketplace health plans are the most common choice during Special Enrollment Periods, they’re not the only option for Central Oregonians. Depending on your needs and budget, you may want to explore alternatives that often provide more flexibility and lower monthly costs.
Medical cost-sharing programs
These community-based programs allow members to share medical expenses. Many healthy individuals and families in Bend and Redmond choose these alternative programs because they can cut costs by 30–50% compared to traditional insurance while providing protection against large, unexpected medical bills.
Direct primary care (DPC)
With DPC, you pay a flat monthly fee for unlimited access to a local doctor. This often includes same-day appointments, extended visits, and other services. While not a substitution for more comprehensive health coverage, pairing DPC with a co-op or high-deductible plan can give you both affordable everyday care and financial protection.
Hybrid approaches
Some Central Oregon residents combine a Marketplace plan (to secure subsidies and network access) with a DPC membership for personal, affordable primary care. Others use medical cost-sharing programs for major expenses and DPC for routine care.
If you’re in Bend, Redmond, or anywhere in Central Oregon, you don’t have to settle for one-size-fits-all insurance. Exploring all your options—Marketplace, cost-sharing, or DPC—can help you build a coverage strategy that actually fits your life.
Important SEP changes coming in 2026
Starting in 2026, several key changes will affect Special Enrollment Periods—and the eligibility rules will start getting a bit tighter. Here’s what Central Oregonians need to know:
- No more income-based SEPs for low-income households
As of August 25, 2025, the monthly SEP that many low-income individuals and families relied on (for those earning at or below 150% of the Federal Poverty Level) has been eliminated—and won’t return in 2026 unless new legislation reverses this change. - More documentation required upfront
Starting in 2026, most SEP applications—especially those approved due to loss of coverage or changes in residence—will require pre-enrollment verification. That means you’ll need to submit documents before your coverage even starts. (NOTE: a court ruling on August 22, 2025 has stayed this provision for now.) - $5 monthly fee for zero-premium auto-renewed plans
If you’re auto-renewed into a $0 monthly premium plan and don’t actively confirm your eligibility, you’ll now be charged $5 per month until you verify your eligibility. The intention here is to keep consumers engaged and aware of their ongoing eligibility. (NOTE: a court ruling on August 22, 2025 has stayed this provision for now.) - Shorter open enrollment period takes effect soon
While more crucial for the broader enrollment landscape, this is still relevant. Starting in 2027, Open Enrollment will end by December 31 nationwide, instead of extending into January. This will make SEPs even more critical for mid-year plan changes.
Why this matters for you
- Be proactive with documentation. Don’t wait for enrollment deadlines—collect your move notice, paycheck stub, loss-of-coverage letter, or other proof ahead of time.
- Act promptly on life changes. With timelines and guidelines changing, don’t wait until the last minute.
- Engage annually. Auto-renewal is no longer a “set and forget” strategy. Confirm your eligibility to avoid unpleasant surprises.
FAQs about SEPs in Oregon
Do all moves qualify me for a Special Enrollment Period?
Not necessarily. Your move must give you access to new plan options—like relocating to Bend, Redmond, or anywhere else in Central Oregon from another state. A general guideline is if you’ve moved outside of your old plan’s service area. You also must have had qualifying health coverage for at least one day in the 60 days before your move.
How long does my SEP last?
You usually have 60 days from the date of your qualifying event to act. Your coverage start date depends on when you apply—so enrolling sooner helps you avoid gaps.
Can small businesses get coverage outside open enrollment?
Yes. Small-group plans can be started any time of year in Oregon. That means business owners in Bend, Redmond, Sisters, or Prineville don’t have to wait for November to offer employee coverage.
Do medical cost-sharing plans follow SEP rules?
No. Medical cost-sharing programs accept members year-round. They can be a great alternative if you miss your SEP (or if you want a lower-cost solution that could save you up 50%).
Next steps: Use your SEP wisely
Special Enrollment Periods give Central Oregonians flexibility when life throws a curveball. If you’ve recently moved, changed jobs, lost coverage, or welcomed a new family member, you likely qualify for a 60-day window to secure new coverage.
This is your chance to make sure you have the right plan. Or, if traditional insurance isn’t the best fit, it’s a good time to explore alternative coverage options that many locals use to save money and get better care.
Don’t wait until open enrollment—act during your SEP window and lock in coverage that fits your new life in Central Oregon!
👉 Take the guesswork out of it — schedule a free coverage review today.