How Qualifying Life Events let you buy health insurance

A qualifying life event is an event that changes your family or health insurance situation and qualifies you for a Special Enrollment Period. The most common qualifying life events are the loss of health care coverage, a change in your household such as marriage or birth of a child, or a change of residence. Denial or loss of coverage from public programs like Medicaid will also make you eligible for a Special Enrollment Period. We’ll discuss the different types of qualifying events and examples of each.

In this article:

• Special Enrollment Period and qualifying events
• Loss of coverage
• Change in household
• Change in status or residence
• Medicaid and CHIP
• Special circumstances

Special Enrollment Period and qualifying events

If you need health insurance and can’t get it through your work, you can only buy an individual plan on the health insurance marketplace during Open Enrollment, a 45-day period that starts in the fall for a plan that begins the following year. (Open Enrollment begins November 1, 2019 for health plans that start January 1, 2020.)

Outside of the annual Open Enrollment Period, you must have a qualifying life event in order to be eligible to buy a health insurance plan.

Qualifying life events are specific events determined by the government. If you experience one of them, then a Special Enrollment Period will open up, during which you can shop for a health plan. A Special Enrollment Period is typically 60 days.

If you don’t have a qualifying life event

If aren’t able to get health coverage during either of the enrollment periods, then you can find other alternatives, like a short-term insurance plan. This flexible plan usually lasts a few months and can be renewed. However, a short-term plan doesn’t meet the minimum essential coverage (MEC) required by the government, so you may wind up with coverage that is inadequate for your needs.

Americans age 65 and older can get health coverage through Medicare while lower income households might be able to qualify for Medicaid, which we’ll discuss later.

Loss of coverage

Losing your current health care coverage is one of the most common qualifying events. Here are common reasons you might lose coverage:

• Resigning from current employment
• Being fired or let go from your job
• Losing Medicare, Medicaid or CHIP (Children's Health Insurance Plan) eligibility. More on this later
• Turning 26 and losing coverage under a parent’s plan
• Death of a family member resulting in your loss of coverage
• COBRA coverage ends (prematurely ending COBRA by either cancelling it or not paying the premiums will not qualify)

Change in household

The following family-related changes may qualify as a life event:

• Marriage
• Divorce or legal separation
• Birth or adoption of a child, or gaining a dependent in another legal way, like child support
• Losing a dependent, such as through placing a child into adoption or foster care
• Spousal abandonment. If you can’t locate your spouse after attempting to find them or you’re a survivor of domestic abuse, and want to enroll in your own plan, you may qualify for a new enrollment period.

Change in status or residence

You can get health coverage through a qualifying life event if you become a citizen or gain other “lawful presence in the U.S.” such as permanent residence or a green card. Additionally, leaving incarceration (prison or jail) will also trigger a Special Enrollment Period.

Finally joining a federally recognized tribe is a qualifying event. You can check this list of which tribes are recognized by the federal government.

Where you live affects your coverage. Health insurance doesn’t always move with you. When you change your primary residence, your current health plan may not be offered in your area. Even a small move to a different county or a new ZIP code may be enough to constitute a qualifying event.

Medicaid and CHIP

Medicaid and the Children’s Health Insurance Program are forms of public assistance offered by the government. If you meet the eligibility requirements then you can enroll in these programs at any time. You can check out the income requirements and more in our state by state guide to Medicaid.

Denial or release from these programs are both considered qualifying events.

• If you apply to either program and are denied coverage, then you will be eligible for Special Enrollment.
• If you already have Medicaid or CHIP and you lose coverage, then you will also qualify for a Special Enrollment Period.

Learn more about Medicaid and if you're eligible for it.

Special circumstances

If you experienced extraordinary circumstances during the initial enrollment period — like an injury or natural disaster — that prevented you from buying health insurance, the government may let you qualify for a Special Enrollment Period.

You might also be eligible for a Special Enrollment Period if you experienced any technical errors or misinformation when trying to buy an individual health plan on healthcare.gov.

Contact the Marketplace Call Center for more information.

Policygenius’ editorial content is not written by a certified financial planner or advisor. It’s intended for informational purposes only and should not be considered legal, financial, or investment advice. Consult a professional to learn what financial products are right for you.

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