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You can buy health insurance outside of the Open Enrollment Period.
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 plan
Loss of coverage, changes to family, marital status, and other situations can qualify you for Special Enrollment
You typically have 60 days after a qualifying life event to 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.
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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 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.
Losing your current health care coverage is one of the most common qualifying events. Here are common reasons you might lose coverage:
The following family-related changes may qualify as a life event:
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.
Health insurance can help pay for your medical expenses.
Health insurance coverage pays for medical expenses you can't afford out of pocket.
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.
Learn more about Medicaid and if you're eligible for it.
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.
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.
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.
This post contains references to products or services from one or more of Policygenius' advertisers or partners. While these codes earn us a small fee at no additional cost to you, they do not influence editorial content and we only refer products we love.
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