Understanding Life Events: Impact On Health Insurance Coverage

A qualifying life event is a significant change in an individual's life situation that impacts their health insurance coverage. These events allow individuals to purchase or modify their health insurance plans outside of the standard annual Open Enrollment Period. Qualifying life events typically include circumstances such as gaining or losing health coverage, changes in residence or household composition, and shifts in employment status. These events trigger a Special Enrollment Period (SEP), during which individuals can adjust their health insurance plans to accommodate their new life circumstances.

Loss of health insurance

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

• 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 COBRA coverage
• Losing individual health insurance coverage for a current plan you bought yourself
• Losing coverage through a family member, such as a parent or spouse

How to Sign Up for a New Health Insurance Plan

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 following a qualifying life event. If you know you will soon experience a qualifying life event, it is recommended that you contact your insurer or the Marketplace in advance to avoid a coverage gap. If the life event is unexpected, you should contact your insurer or the Marketplace as soon as possible after the event occurs to understand your coverage options.

When enrolling in a new plan, you may be required to provide documentation of your qualifying life event. For example, if you have lost your coverage through a family member, you may need to provide a death certificate or divorce paperwork.

Change in residence

A change in residence is a qualifying life event (QLE) for health insurance. Moving to a new location can impact your insurance options, and you may need to change your health insurance plan outside the yearly Open Enrollment Period.

A change in residence may qualify you for a Special Enrollment Period (SEP), which is when you can sign up for a new health insurance plan or change an existing one outside the Open Enrollment Period. To qualify for an SEP, your new location must offer different insurance options from your previous one. This could include moving to a different zip code, county, or state that changes your health plan area.

For example, if you move to an area where your current coverage is not available, you will need to explore new plans. Alternatively, if your current coverage is still available, there may be new plans in your new location that better suit your needs.

If you are a student, moving to or from school can be considered a change in residence and, therefore, a qualifying life event. The same applies to seasonal workers moving to or from a work location. Moving in or out of a shelter or transitional housing is also a qualifying life event. Moving to the US from a US territory or foreign country can also be a qualifying life event.

If you experience a change in residence, it is important to contact your insurer or the Marketplace to understand your coverage options and determine if you are eligible for an SEP. You may be required to provide documentation of your move, such as new rental agreements, deeds, or mortgages.

Change in employment status

A change in employment status is a qualifying life event that can make you eligible for a Special Enrollment Period (SEP) to change your health insurance plan outside the yearly Open Enrollment Period. This period typically lasts 30-60 days before or after the qualifying event, during which you can make plan changes or sign up for new coverage.

Under the Affordable Care Act (ACA), a change in employment status may trigger a Special Enrollment Period. This is applicable when the change in employment affects your eligibility for health insurance. For example, if you quit your job or are fired and lose your group health insurance, this is considered an involuntary loss of coverage, and you can qualify for a Special Enrollment Period. In such cases, you have 60 days from the date of losing group coverage to purchase new health insurance.

Changing job positions can also qualify you for a Special Enrollment Period. This applies if you take a new job that doesn't offer health coverage or if your new position within the same company no longer qualifies you for group insurance. For instance, transitioning from a full-time position with benefits to a part-time role that doesn't qualify for benefits. Your Special Enrollment Period begins on the day you lose coverage and lasts for 60 days.

Additionally, a change in employment status can include situations where there is a switch between full-time and part-time employment, a strike or lockout, or an unpaid leave of absence. These changes may trigger a review of your health insurance options and potentially lead to adjustments in your coverage.

Change in household

A change in household is a qualifying life event for health insurance, allowing you to make changes to your health plan outside of the Open Enrollment Period. This includes changes such as getting married, divorced, or separated, as well as adding or losing household members.

Marriage, Divorce, and Separation

Getting married is a significant change that can impact your health insurance coverage. When you get married, you may want to add your spouse to your existing plan or choose a new plan that offers coverage for both of you. Similarly, if you are going through a divorce or separation, you may need to remove your spouse from your current plan or find alternative coverage.

Adding Household Members

Having a baby, adopting a child, or taking in a foster child are all considered qualifying life events. These events can trigger a Special Enrollment Period, allowing you to add the new dependent to your current plan or enrol them in their own plan. It's important to note that current enrollees typically cannot change plans during this period, but you may be able to enrol together in a different plan within the same category or one level up or down.

Losing Household Members

Losing a household member can also impact your health insurance coverage. This may include a death in the family, a child turning 26 and aging out of the family plan, or a dependent being lost through other means, such as a court order. In these cases, you may need to remove them from your current plan and make adjustments to your coverage.

It's important to note that documentation may be required when making changes to your health insurance due to a qualifying life event. This could include birth certificates, adoption records, marriage licenses, divorce paperwork, or death certificates.

Change in eligibility

Changes in eligibility can be a qualifying life event (QLE) that allows you to enrol in health insurance outside of the annual Open Enrollment Period. This includes changes in income that affect the coverage you qualify for, such as eligibility for Medicaid coverage. For example, if you are no longer eligible for Medicaid, you will qualify for a Special Enrollment Period (SEP).

Other changes in eligibility that count as QLEs include becoming eligible for tax credits that lower premiums, and gaining membership in a federally recognised tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

If you are unsure whether a change in eligibility applies to you, contact your insurer or the Marketplace to find out if you are eligible.

Frequently asked questions