Your guide to qualifying life events

A qualifying life event (QLE) is a life change, like marriage or losing your job, that allows you to buy health insurance outside of the Open Enrollment Period.

Elissa

By

Elissa Suh

Elissa Suh

Personal Finance Editor

Elissa Suh is a senior editor of estate planning at Policygenius in New York City. She has researched and written extensively about wills, trusts, and personal finance since 2019, with an eye towards making difficult (and at times gloomy) topics easy to understand for readers. Her articles and data stories has been cited by the likes of MarketWatch, CNBC, PBS, Inverse, The Philadelphia Inquirer, and more.

Updated October 29, 2020|2 min read

Policygenius content follows strict guidelines for editorial accuracy and integrity. Learn about our

editorial standards

and how we make money.

Key Takeaways

  • A qualifying life event (QLE) is necessary to buy health insurance outside of the standard enrollment period

  • The qualifying event triggers a Special Enrollment Period during which you can enroll in a health plan

  • You can qualify for Special Enrollment due to changes to your family status, marital status, employment status, or others changes where you lose coverage

  • You typically have 60 days after a qualifying life event to buy health insurance

A qualifying life event (QLE) is an event that changes your family or health insurance situation and qualifies you for a Special Enrollment Period. Special Enrollment Periods are generally the only way to change your health insurance plan outside of the annual Open Enrollment period — the 45-day period that starts in the fall for a plan that begins the following year. (Open Enrollment began November 1, 2020 for health plans that start January 1, 2021.)

Common qualifying life events are the loss of health care coverage when you leave your job, getting married, having a child, moving, or losing existing coverage under a parent’s plan because you turned 26. You also qualify for Special Enrollment if you lost your employer-sponsored health insurance because of the coronavirus pandemic (COVID-19).

Special Enrollment Periods generally start the day of your qualifying event and last for 60 days. You can qualify for Special Enrollment whether you had health coverage from an employer or through the Obamacare marketplace. You may need to show supporting documents, like a new child’s birth certificate, to prove you qualify. To shop new plans, you can either visit healthcare.gov (or your state’s marketplace) to get a plan through the marketplace, or you can notify your employer that you qualify for a Special Enrollment Period. For more help, try our guide to Special Enrollment Periods.

Types of qualifying life events

There are four main types of qualifying events according to Healthcare.gov, which manages the health insurance marketplace — life events that result in a loss of your health coverage, changes in your household, changes in your residence, and other special circumstances. Below you can find a list of common qualifying life events that you may experience:

  • Leaving your current employment, whether you resign, get fired, or are otherwise let go

  • Losing coverage or being denied coverage for Medicare, Medicaid, or CHIP (Children's Health Insurance Plan) eligibility. (Find your local eligibility requirements in our state by state guide to Medicaid.)

  • Turning 26 and losing health coverage under a parent’s plan

  • Death of a family member, resulting in your loss of coverage

  • COBRA coverage ends (you don’t qualify if you prematurely end COBRA by either cancelling it or not paying the premiums)

  • Marriage (usually including a common-law marriage or domestic partnership)

  • Divorce or legal separation

  • Birth or adoption of a child

  • Gaining an eligible dependent, like through child support, a court order, by caring for an elderly parent

  • Losing an eligible dependent, such as through placing a child into adoption or foster care

  • Spousal abandonment, including situations where you can’t locate your spouse after attempting to find them or if you’re a survivor of domestic abuse and need to enroll in your own plan

  • Moving to a new zip code or county where your current insurance coverage is not offered

  • Moving to or from the place where you attend school, if you’re a student

  • Moving your home for seasonal work

  • Becoming a U.S. citizen

  • Gaining other “lawful presence in the U.S.” such as permanent residence or a green card

  • Leaving incarceration (prison or jail)

  • Joining a federally recognized tribe

  • Leaving active duty or otherwise losing TRICARE coverage

Special circumstances

If you experienced extraordinary circumstances that prevented you from buying health insurance during the initial enrollment period, the government may grant you a Special Enrollment Period. Special circumstances that may qualify you for Special Enrollment include an injury, a natural disaster, technical errors during your enrollment period, or misinformation on the marketplace site when trying to buy an individual health plan on healthcare.gov.

To request a Special Enrollment period because of special circumstances or to get more, contact the Marketplace Call Center.

What if you don’t have a qualifying life event?

If you can’t get health coverage during either type of enrollment period, then you may want to consider 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 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 insurance coverage through Medicare while lower income households might qualify for Medicaid.

Learn more in our state-by-state guide to Medicaid.

Pull Quote - Life

Health insurance and life insurance work together to offer financial protection.

Health insurance can pay your medical expenses. Life insurance keeps your loved ones whole after you die.