Qualifying Life Events For Health Insurance

What Is A Qualifying Life Event?

Certain changes in your life situation are known as qualifying life events – and typically include circumstances that may impact your current health insurance coverage and make it necessary to enroll in a new plan. These events include a loss of health coverage, a change in your household, or a change in residence and can qualify you for a Special Enrollment Period (SEP). SEPs are generally the only time when you can sign up for a new health insurance plan or change an existing health insurance plan outside the Open Enrollment Period.

Types of Qualifying Life Events

Qualifying life events generally fall into different categories depending on the type of change you experience.

Loss of health coverage

You may qualify for an SEP if you or any member of your household loses their existing coverage. Loss of coverage events may include:

• Losing your job and employer-sponsored insurance
• Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)
• Turning 26 and losing coverage from your parent’s health plan

Household changes

Household changes involve a circumstance in which one or more members of your immediate household become eligible—or lose eligibility—for coverage under an existing plan. These may include, but are not limited to:

• Getting married
• Getting divorced
• Having a baby or adopting a child
• Experiencing a death of the primary policyholder in the family

Changes in residence

Changes in residence involve relocating, particularly if your new location impacts the insurance options you have available to you. This may include moving to a different zip code, county, or state that changes your health plan area.

There are other life changes beyond these listed events that might qualify you for a Special Enrollment Period. If you have experienced a significant change that you think may qualify you for an SEP, contact your insurer, or the Marketplace, to find out if you are eligible.

How to Sign Up for Health Insurance if You Experience a Qualifying Life Event

You can anticipate certain life-changing events, while others are unexpected, but it is important to plan ahead whenever possible. Under the guidelines set by the Affordable Care Act (ACA), you can typically make changes to your health insurance plan within 60 days leading up to — or 60 days following — a qualifying life event.

If you know you will soon experience a qualifying life event, contacting your insurer or the Marketplace in advance can help avoid a coverage gap. If you experience an unexpected life change, contact your insurer or the Marketplace as soon as possible after the event occurs to understand your coverage options.

When enrolling in a plan, you may be required to provide documentation of your qualifying life event. Documentation often depends on the event and could include:

• Birth certificates, adoption records, and marriage licenses that show you have added family members and need to modify your health insurance coverage.
• Divorce paperwork, or a death certificate that show a family member who had previously provided you with health insurance coverage.
• New rental agreements, deeds, or mortgages that show you have moved into a new health insurance plan area.

These are just a few examples of the types of documents you may need. If you think you are experiencing a qualifying life event, speak to your health insurer or the Marketplace to understand what documents might be necessary for eligibility.

What If I Do Not Qualify For A Special Enrollment Period?

If you do not meet the qualifications for an SEP, you still have options for coverage. For example, you may be eligible to enroll in Medicaid. Medicaid is a government-run health insurance program that provides coverage for millions of individuals and families who meet certain income and other eligibility requirements. It is designed to provide health plans for low-income individuals, children, pregnant women, and people with disabilities. You do not need to experience a qualifying life event to apply for and enroll in Medicaid.