Understanding Insurance Activation After A Life Event

A qualifying life event (QLE) is a life-changing situation that impacts your health insurance. It allows you to change your health plan outside of the annual Open Enrollment Period. Depending on your plan, a QLE gives you 30 or 60 days to make changes or sign up for new coverage.

QLEs include:

- Loss of health insurance coverage

- Changes in household, such as getting married, divorced, or having a baby

- Changes in residence

- Changes to your eligibility, such as changes in income or becoming a US citizen

Loss of health insurance coverage

Losing your health insurance coverage is a qualifying life event that can impact you and your health insurance. It is considered a significant life change that allows you to change your health plan outside of the annual enrollment period. This typically includes circumstances where you or any member of your household loses their existing coverage. Here are some examples of events that qualify as a loss of health insurance:

• Losing employer-sponsored coverage, which can happen if your employer drops your current coverage or you experience a reduction in work hours.
• Losing COBRA coverage due to the coverage period ending or your former employer ending their contributions.
• Losing individual health insurance coverage for a current plan you bought yourself, such as your insurance carrier stopping offering your individual policy or you losing eligibility for student health coverage.
• Losing eligibility for coverage for government-sponsored programs like Medicaid or the Children's Health Insurance Program (CHIP).
• Losing eligibility for Medicare, specifically Medicare Part A.
• Losing coverage through a family member, such as turning 26 and losing coverage through a parent's plan, a family member's employer plan cutting health coverage for dependents, or the death of a family member.

If you experience a loss of health insurance coverage, you may qualify for a Special Enrollment Period (SEP), which allows you to apply for essential health insurance coverage outside of the yearly Open Enrollment Period. The SEP typically lasts for 60 days before or after the qualifying life event, though specific dates may vary by state. To avoid a coverage gap, it is recommended to contact your insurer or the Marketplace as soon as possible after the event occurs to understand your coverage options and any documentation requirements.

Changes in household

Household changes involve circumstances in which one or more members of your immediate household become eligible for or lose eligibility for coverage under an existing plan. These changes can trigger a Special Enrollment Period (SEP), which is a period during which you can apply for new health insurance coverage or change an existing plan outside of the Open Enrollment Period.

• Marriage or divorce: Getting married or divorced can impact your health insurance needs and coverage. You may need to add or remove your spouse from your existing plan.
• Having a baby or adopting a child: When you have a new baby, adopt a child, or receive a foster child, your health insurance needs may change. You will need to add the new family member to your health insurance plan.
• Death of a family member on your health insurance policy: If you experience the death of a family member who was on your health insurance plan, you may need to make changes to your coverage.
• Changes in residence: Moving to a new location, especially if it impacts the insurance options available to you, can be considered a change in household. This could include moving to a different zip code, county, or state, or relocating between states.
• Changes in family composition: In addition to having a baby or adopting, other changes in family composition can qualify as QLEs. For example, if adult children turn 26 and are no longer eligible for their parent's plan, or if a spouse loses their job and their employer-sponsored insurance.

It's important to note that the specific requirements and timeframes for making changes to your health insurance after a qualifying life event may vary depending on your insurance provider and your location. Be sure to review your plan materials, contact your employer, or reach out to the phone number on your member ID card for specific information. Additionally, you may be required to provide documentation to support your qualifying life event, such as marriage certificates, birth certificates, or proof of residency.

Changes in residence

If you have private health insurance, you may qualify for a Special Enrollment Period (SEP) if you move out of your current health plan's service area. You will also qualify for an SEP if you move to an area that is still covered by your plan but where more plans are now available to you. The length of your SEP depends on when you notify your insurance provider of your move. To ensure you have coverage at your new address, it is recommended that you notify your provider in advance of your move.

If you have Original Medicare, you do not need to make changes to your coverage when moving out of state or within your own state. Original Medicare does not have provider networks, so you can visit any doctor or facility in the country that accepts Medicare. However, you should still contact Social Security to update your information to ensure that you receive important communications.

If you have Medicare Advantage Plans and Part D plans, these have coverage areas, so you may need to switch plans when you move. If you are moving abroad, you should disenroll from these plans as you will not be eligible for them while living overseas.

If you are moving, it is important to review your insurance coverage and understand any changes that may be needed. Contact your insurance provider or agent to discuss the process and any requirements at your new location. Ask about transferring insurance to another state and the insurance requirements for your new location.

Additionally, if you are renting or buying a new home, consider homeowners insurance or renters insurance to protect your property. Coverage may vary depending on your location, so it is important to understand the insurance requirements in your new state.

Changes to eligibility

• Changes in income that affect your eligibility for Medicaid coverage.
• After already having an ACA plan, becoming eligible for tax credits that lower premiums.
• Becoming a member of a federally recognised tribe.
• For new US citizens, becoming eligible for Marketplace coverage.
• For AmeriCorps VISTA members, beginning or ending service.
• Being discharged from the military.
• Being released from incarceration.

In addition, exceptional circumstances can also qualify a person for a Special Enrollment Period. For example, if someone working in an official capacity prevented enrolment, made a mistake in enrolment, gave wrong information, etc.

Special enrollment period examples

Special Enrollment Period (SEP) is a period of time outside of the yearly Open Enrollment when you can sign up for health insurance. SEPs are generally the only time when you can sign up for a new health insurance plan or change an existing one outside the Open Enrollment Period.

• Changes in household: Getting married, having a baby, or adopting a child are all considered qualifying life events for a Special Enrollment Period. These events can trigger a change in your health insurance needs, and you may need to update your plan accordingly.
• Changes in residence: Moving to a different ZIP code, county, or state can impact the insurance options available to you. If your new location offers different health plans, you may be eligible for a Special Enrollment Period to choose a plan that better suits your new area.
• Loss of health coverage: Losing your existing health coverage, such as job-based insurance, individual plans, or student health plans, is a qualifying life event. This also includes losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).
• Turning 26 and losing coverage through a parent's plan: When individuals turn 26, they are typically no longer eligible for their parent's health insurance plan. This milestone triggers a Special Enrollment Period, allowing them to find their own health insurance plan.
• Death of a family member: If a member of your family who was enrolled in your health plan passes away, this can be a qualifying life event. You may need to make changes to your plan to ensure continued coverage for the rest of your household.
• Change in employment status: Whether voluntary or involuntary, a change in your employment status can be a qualifying life event. This includes situations such as being laid off, dismissed, resigning, or retiring. You may need to explore different health insurance options during this transition.
• Natural disaster relief: In the event of a natural disaster, such as an earthquake, flooding, or a hurricane, you may qualify for a Special Enrollment Period. This allows individuals and families impacted by these events to address their health insurance needs during a challenging time.

Frequently asked questions