Navigating Insurance Applications: Qualifying Life Events

A qualifying life event is a change in your life situation that makes you eligible to enroll in health insurance outside of the annual Open Enrollment Period. This period usually lasts from November 1 to January 15, but specific dates vary by state. Qualifying life events include changes in residence, household, and income, as well as the loss of health coverage. For example, if you lose your job and your employer-sponsored insurance, you may qualify for a Special Enrollment Period (SEP), which allows you to apply for new insurance coverage or change your existing plan outside of the Open Enrollment Period. To apply for insurance with a qualifying life event, you will typically need to provide documentation, such as birth certificates, marriage licenses, or proof of residency, depending on the type of event.

Loss of health coverage

• 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
• Losing your COBRA coverage
• No longer being eligible for student health coverage
• Losing your Medi-Cal coverage

If you anticipate a loss of health coverage, it is recommended to contact your insurer or the Marketplace in advance to avoid a coverage gap. If the loss of coverage occurs unexpectedly, be sure to reach out to your insurer or the Marketplace as soon as possible to understand your options.

During the Special Enrollment Period, you typically have 30 to 60 days before or after the qualifying life event to make changes to your health insurance plan or sign up for a new one. It is important to note that you may be required to provide documentation of your qualifying life event when enrolling in a new plan or making changes to an existing one.

Changes in household

Marriage or Domestic Partnership

If you get married or enter into a domestic partnership, you can use the special enrollment period to enroll in a new health insurance plan or make changes to an existing one. You will need to provide a marriage certificate or relevant documentation to prove your change in marital status.

Divorce or Separation

Divorce or separation can also lead to a QLE. You may need to adjust your health insurance plan to reflect your new situation. Court papers or legal documentation related to the divorce or separation will likely be required during the enrollment process.

Parenthood

Becoming a parent, either through childbirth, adoption, or fostering, is considered a significant change in household composition. The entire family can use the special enrollment period to update their health insurance coverage. Birth certificates, adoption records, or foster care placement documents will be necessary to demonstrate this change in your household.

Death of a Policyholder

The death of a primary policyholder in the family can result in changes to the health insurance coverage for the remaining household members. During the special enrollment period, you can make adjustments to your plan to reflect this unfortunate change in circumstances. A death certificate and other relevant documentation may be requested by the insurer.

Changes in residence

Moving to a Different Zip Code or County

This could include relocating to a new neighbourhood or city within your current state. This may be considered a QLE if your new location offers different insurance options or changes your health plan area.

Moving Between States

If you move to a different state, your health plan area will likely change, impacting the insurance options available to you. This could be a qualifying life event that allows you to adjust your health insurance coverage accordingly.

Student Housing Changes

Students who move to or from their school residence may qualify for a QLE. This could involve relocating to a new city or state for school or returning to a permanent residence during school breaks.

Seasonal Worker Housing Changes

Seasonal workers who move to or from their work location may also qualify for a QLE. This could be a result of taking on a temporary job in a different location or returning to a permanent residence after the seasonal work ends.

Transitional Housing

Moving in or out of a shelter or transitional housing can be considered a QLE. This includes situations of housing instability or transitioning between permanent residences.

Relocating to the US

If you are moving to the US from a US territory or foreign country, you may qualify for a QLE. This could involve establishing residency in the US and gaining access to different insurance options.

It's important to note that the specific requirements and qualifications for a QLE due to changes in residence may vary depending on your insurance provider and location. Be sure to contact your insurer or the Marketplace to understand their specific criteria and provide the necessary documentation to support your QLE claim.

Changes to your eligibility

Aside from the examples above, there are additional circumstances that are considered to be qualifying life events, which may impact your eligibility for insurance. These include:

• Changes in income that affect your eligibility for Medicaid coverage.
• After already having an ACA plan, becoming eligible for tax credits that lower your premiums.
• Becoming a member of a federally recognised tribe or gaining status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
• 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.

If you have experienced a significant change that you think may qualify you for a Special Enrollment Period, contact your insurer or the Marketplace to find out if you are eligible.

Other qualifying events

A qualifying life event for insurance is a change in your life situation that makes you eligible to enrol in health insurance outside of the annual Open Enrollment Period. There are four basic types of qualifying life events: loss of health coverage, changes in household, changes in residence, and other qualifying events.

• Changes in income that affect the coverage you qualify for. For example, if your income decreases and you become eligible for Medicaid, you may qualify for a Special Enrollment Period (SEP).
• Gaining membership in a federally recognised tribe or becoming a shareholder in an Alaska Native Claims Settlement Act (ANCSA) Corporation.
• Becoming a US citizen.
• Leaving incarceration (jail or prison).
• AmeriCorps members starting or ending their service.
• Being affected by an unexpected and uncontrollable event or natural disaster, such as an earthquake, massive flooding, or a hurricane.
• Being kept from enrolling during Open Enrollment due to a serious medical condition or a natural disaster.
• Technical errors during your enrollment, such as incorrect eligibility determination or errors in processing your verification documents.
• Gaining a new dependent or becoming dependent on someone else due to a court order.
• Surviving domestic abuse or spousal abandonment and enrolling in a new, personal health policy.

Frequently asked questions