Navigating Life Events: Losing Health Insurance Coverage

Losing your health insurance can be stressful, but it's important to know that it may count as a qualifying life event, allowing you to enroll in a new health insurance plan outside of the standard open enrollment period. This is known as a Special Enrollment Period (SEP), which is typically triggered by a significant change in your life circumstances, such as losing your health coverage.

Involuntary loss of health insurance coverage, such as losing your job or your employer dropping your current coverage, generally qualifies as a qualifying life event. However, it's important to note that voluntarily dropping your coverage, such as by not paying your premiums, usually does not qualify for an SEP.

Involuntary loss of health insurance is a qualifying life event

Losing your health insurance can be stressful, but there are solutions. If you've lost your health insurance, it's important to know that an involuntary loss of health insurance is a qualifying life event that triggers a special enrollment period (SEP). This means that you can enroll in a new health insurance plan outside of the annual open enrollment period. Here are some important things to know about involuntary loss of health insurance as a qualifying life event:

Types of Involuntary Loss of Health Insurance

There are several scenarios that can result in an involuntary loss of health insurance:

• Losing employer-sponsored coverage due to job loss or leaving a job
• Losing coverage due to changes in income that affect eligibility, such as no longer qualifying for Medi-Cal or CHIP
• Losing COBRA coverage due to expiration or termination of contributions by your former employer
• Aging out of a parent's plan when turning 26 years old
• Losing student coverage after graduating or otherwise leaving school
• Losing coverage due to an insurer leaving the market

Qualifying Life Event Criteria

For an involuntary loss of health insurance to be considered a qualifying life event, certain criteria must be met. The lost coverage must meet the requirements for minimum essential coverage as defined by the Centers for Medicare and Medicaid Services. However, there are exceptions, such as losing pregnancy-related Medicaid coverage or the termination of a short-term health insurance plan when applying for a new employer-sponsored plan. It's important to note that losing coverage due to legal rescission by the insurer for fraud or intentional misrepresentation is not considered a qualifying life event.

Special Enrollment Period (SEP)

The special enrollment period typically lasts for 60 days after the qualifying life event. In some cases, you may also have access to the special enrollment period in the 60 days leading up to the loss of coverage if you know about it in advance. During this time, you can enroll in a new health insurance plan, either through the exchange/marketplace in your state or directly through an insurer. It's important to act quickly to avoid any gaps in coverage.

COBRA Coverage

If you lose your job and your employer-sponsored coverage, you may have the option to continue your health coverage through the COBRA program. However, losing your regular employer-sponsored coverage is still considered a qualifying life event, and you can choose to elect COBRA or select a new plan during the special enrollment period. Remember that special enrollment is only available for 60 days, so carefully consider the costs, benefits, and risks of any coverage gaps when deciding between COBRA and a new plan.

In summary, an involuntary loss of health insurance is a qualifying life event that triggers a special enrollment period, allowing you to enroll in a new health insurance plan outside of the annual open enrollment period. This helps to ensure that you don't experience a gap in coverage due to circumstances beyond your control.

You can apply for a new health plan during a Special Enrollment Period (SEP)

Losing your health insurance is considered a qualifying life event and allows you to apply for a new health plan during a Special Enrollment Period (SEP). This is a period outside the yearly Open Enrollment Period when you can sign up for health insurance. Depending on your situation, you may have 60 days before or after the event to enrol in a plan.

There are four basic types of qualifying life events:

Loss of Health Coverage:

• Losing job-based coverage, including COBRA coverage.
• Losing individual health insurance coverage for a current plan you bought yourself.
• Losing eligibility for Medicaid, CHIP, or Medicare.
• Losing coverage through a family member.

Offer of a New Health Benefit:

If your employer offers you a new health benefit, such as a Health Reimbursement Arrangement (HRA), you will have access to a 60-day SEP to pick a qualified health plan.

Changes in Household:

• Getting married or divorced.
• Having a baby, adopting a child, or placing a child in foster care.
• Death of a spouse or dependent listed on your policy.

Changes in Residence:

• Moving to a new ZIP code or county (if it's outside your plan's service area).
• Moving to or from the place you attend school if you're a student.
• Moving to or from a shelter or transitional housing.

In addition to these qualifying life events, other circumstances may also allow you to apply for a new health plan during an SEP. For example:

• Experiencing an exceptional circumstance, such as a serious medical condition or natural disaster.
• Gaining or becoming a dependent due to a court order.
• Experiencing domestic abuse or spousal abandonment.
• Living at the federal poverty level and qualifying for a low-income SEP.

You have 60 days before/after the event to apply for a new plan

Losing your health insurance is considered a qualifying life event, which allows you to enrol in a new health insurance plan outside of the annual Open Enrollment Period. This is known as a Special Enrollment Period (SEP).

The SEP typically lasts for 60 days before or after the qualifying life event, giving you a window to apply for a new plan. This period may vary depending on your state and specific plan, with some offering 30 days, and others providing up to 60 days both before and after the event, resulting in a total window of 120 days.

During the SEP, you can either choose to elect for COBRA (if you lost insurance due to leaving a job) or select a new plan in the individual market. If you opt for COBRA, you will still have access to another SEP when it expires, or you can decline it and choose a new plan during the current SEP.

It is important to note that if you voluntarily dropped your coverage, did not pay your premiums, or chose to leave a parent or guardian's plan, you may not qualify for the SEP. Additionally, if you lose your insurance due to rescission, where the insurer cancels the policy due to fraud or intentional misrepresentation, it does not count as a qualifying life event.

You can lose coverage for many reasons, including losing your job

Losing your health insurance can happen for many reasons, and it can be a stressful experience. If you lose your job, you will also lose your job-based health insurance, which is a common reason for losing health coverage. This applies regardless of whether you left your job voluntarily or were dismissed or laid off. Losing job-based health insurance is considered a "qualifying life event", which means you are presented with a special enrollment period to get a new health plan and prevent any gaps in your coverage.

In the event of losing your job-based health insurance, you have two main options: enrolling in a plan through the Health Insurance Marketplace or signing up for COBRA coverage. With the former, you will have 60 days before and after losing your job-based coverage to apply for a new individual health insurance plan. Your coverage can then start the first day of the month after you lose your previous coverage. When applying, you will find out if you qualify for savings on your monthly premiums or a tax credit to lower your monthly insurance payment. You may also be eligible for free or low-cost coverage from Medicaid or the Children's Health Insurance Program (CHIP).

If you opt for COBRA coverage, you can temporarily continue your job-based health insurance for a limited time, usually 18 months, after your job ends. However, you will typically need to pay the full premium yourself, plus a small administrative fee. It is worth noting that COBRA coverage may be more expensive than individual health insurance plans, so it is recommended to explore your options.

In addition to losing your job, there are other reasons why you might lose your health insurance coverage. This includes situations where your insurer exits the market, your insurance carrier stops offering your individual policy, or you move outside of your plan's service area. Losing coverage in these scenarios is also considered a qualifying life event, allowing you to enrol in a new health plan outside of the standard open enrollment period.

You can lose your insurance voluntarily, but this doesn't qualify for an SEP

Losing your health insurance can be considered a qualifying life event, allowing you to enrol in a new health plan with no coverage gap. However, it is important to note that this only applies if the loss of coverage is involuntary. If you lose your insurance voluntarily, it does not qualify you for a Special Enrollment Period (SEP).

Involuntary loss of coverage refers to situations where you did not choose to cancel the plan yourself or stop paying your premiums. For example, if your employer drops your current coverage, or you are fired from a job where you had health insurance, it is considered an involuntary loss. In such cases, you are eligible for an SEP and can enrol in a new health plan.

On the other hand, if you voluntarily drop your health insurance during the plan year or lose your coverage due to non-payment of premiums, you will not qualify for an SEP. This means that choosing to discontinue your insurance does not trigger the same special enrollment period as an involuntary loss would.

It is also important to note that the coverage you are losing must be considered minimum essential coverage. Short-term plans, for instance, are not considered minimum essential coverage, so losing one would not qualify you for an SEP.

Frequently asked questions