Health Insurance 101: What Is a Qualifying Life Event?

Can you get a plan outside of an enrollment period? Only if you have a qualifying life event.

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Usually, you can only enroll in an insurance plan during the open enrollment period. In many cases, that starts in November and runs through December or January. If it’s not the open enrollment period, you can only sign up or change your insurance plan if you’ve had a qualifying life event.

What Is a Qualifying Life Event for Health Insurance?

A qualifying life event is a change in your living situation that makes you eligible for a special enrollment period. That means you can enroll in a plan (or tweak your plan elections) outside of the standard open enrollment period. After all, life doesn’t always follow a tidy, 12-month schedule.

Examples of qualifying life events include:

  1. Moving: This includes moving to a new ZIP code or moving to the U.S. from another country.
  2. Losing your previous coverage: This includes if you lost your job or your eligibility for Medicaid or CHIP. It also includes if you’re a young adult who has aged out of your parents’ coverage or lost your student plan through your university.
  3. Adding or removing a dependent: You may need to add a new dependent to your plan, such as if you got married, or if you had or adopted a child. On the other hand, you might need to remove a dependent, such as if you got a divorce or had a death in the family.
  4. Becoming a U.S. citizen: This makes you eligible to enroll in an insurance plan.
  5. Changes in your income level: For example, if your income level drops enough, you may qualify for Medicaid. On the other hand, your income level may go up enough that you no longer qualify for Medicaid and can enroll in a private plan.
  6. Getting released from jail or prison: No matter what time of year you get released, you are then eligible for a special enrollment period.

Note: This is not an exhaustive list of all types of qualifying life events. Check with your insurance company or the Health Insurance Marketplace to see their full list.

How Long Is the Special Enrollment Period?

After a qualifying life event, you don’t want to procrastinate on signing up for your new insurance plan. Often, you only have around 60 days to enroll or change your coverage. (Check with your insurer’s rules to confirm the exact timeline.)

If you don’t sign up for a plan during the special enrollment period, you’ll have to keep your current coverage until the next open enrollment period. This could be devastating for you and your family if November is several months away.

Don’t stick with insurance that no longer works for you or your household. Find out if you qualify for a special enrollment period by talking to a representative, or by visiting your insurance company’s website.