Understanding Qualifying Life Events For Insurance Changes

A qualifying life event is a significant change in your life situation that allows you to change your health insurance plan outside of the usual annual open enrollment period. These events include circumstances like getting married, divorced, having a baby, or losing your health coverage, which may require you to enroll in a new plan. In the US, individuals typically have 30 to 60 days before or after a qualifying life event to make changes to their health insurance plan.

Loss of health coverage

Losing your health insurance coverage is a qualifying life event (QLE) that 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).

• Turning 26 and losing coverage through a parent's insurance plan
• Losing job-based coverage, COBRA, or a student plan
• Losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP)
• Losing health insurance for any reason other than not paying the premiums

What to Do if You Lose Your Health Insurance Coverage

If you lose your health insurance coverage, you may qualify for an SEP. This means that you can enrol in a new health plan outside of the annual Open Enrollment Period. The timing is usually 30 or 60 days after the life event happens, so it is important to act quickly. Contact your insurer or the Marketplace to understand your coverage options and to find out what documents you need to provide to prove your QLE.

Changes in household

Getting married, separated, or divorced

If an individual gets married, they can qualify to immediately buy or make changes to a health plan. On the other hand, getting a divorce is also a qualifying life event, and the individual may need to change their health insurance plan.

Having a baby, adopting a child, or receiving a foster child

The birth of a child is considered a qualifying life event, and the individual may need to modify their health insurance coverage. Similarly, adopting a child or receiving a foster child also qualifies as a QLE.

Death of a family member on the health insurance policy

The death of a primary policyholder in the family is a household change that can trigger a QLE. This may result in a family member losing their health insurance coverage.

Gaining or losing a dependent

Adding or losing household members can impact the coverage or savings an individual is eligible for. Gaining or losing a dependent can be due to various reasons, such as placing a child for adoption or foster care, or a child on the plan turning 26.

It is important to note that the specific requirements for a QLE may vary, and individuals should contact their insurer or the Marketplace to understand their eligibility and the documentation required.

Changes in residence

Moving to a Different Zip Code or County

If you move to a new location within the same state but in a different zip code or county, this may qualify as a QLE. This is especially true if your new location offers different insurance options or changes your health plan area.

Moving to a Different State

If you relocate to a different state, this can significantly impact your insurance options. Each state has its own unique set of insurance providers, plans, and regulations. Therefore, moving to another state is likely to qualify you for a QLE, as you will need to navigate a new insurance landscape.

Students Moving to or from School

If you are a student and you move to or from your school location, this may be considered a QLE. This is because your insurance needs may change based on your place of residence during the school year and any insurance plans offered by your educational institution.

Seasonal Workers Moving to or from Work Location

Seasonal workers who move to or from their work location may also experience a change in their insurance needs. This could be due to differences in insurance options or coverage areas between their seasonal residence and permanent home.

Moving to or from Transitional Housing

Moving to or from a shelter or other transitional housing can be a qualifying life event. Transitional housing often serves individuals and families experiencing homelessness or those in need of temporary housing solutions. These living situations can impact insurance options and coverage areas, thus qualifying for a QLE.

It is 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. Therefore, it is always a good idea to contact your insurer or the relevant government body to understand their specific criteria and any documentation you may need to provide.

Changes in income

Income changes that affect your eligibility for Medicaid coverage are considered a qualifying life event (QLE) for insurance change. This means that if your income changes and you become eligible for Medicaid, you can make changes to your health insurance plan or sign up for a new plan outside of the yearly Open Enrollment Period.

The Open Enrollment Period is an annual period when individuals and families can purchase a health plan through the Health Insurance Marketplace. This period usually lasts from November 1 to January 15, although specific dates may vary by state. To accommodate unexpected life changes, such as changes in income, a Special Enrollment Period (SEP) is offered.

A Special Enrollment Period allows you to apply for essential health insurance coverage within a specified time frame before or after a qualifying life event. The length of the Special Enrollment Period can vary, typically ranging from 30 to 60 days, depending on your plan and the circumstances of the qualifying event. It is important to note that not all income changes will qualify for an SEP, and there may be specific criteria that need to be met.

If you anticipate a significant income change that may impact your eligibility for Medicaid, it is advisable to contact your insurer or the Marketplace in advance. Planning ahead can help you avoid a coverage gap and ensure a smooth transition to your new insurance plan. They will be able to guide you through the process and inform you of any documentation you may need to provide.

During the Special Enrollment Period, you may be required to submit certain documents to support your qualifying life event. These documents will vary depending on the nature of your income change and the specific requirements of your insurance provider. It is important to be prepared and stay organized with the necessary paperwork to ensure a seamless transition during this period.

Changes in citizenship status

To enrol in health insurance through the exchange (either the federally run HealthCare.gov or a state-run exchange), individuals must provide proof of citizenship or lawful permanent resident status. This can be done by submitting a naturalization certificate. It is important to note that a special enrollment period does not apply if an individual already had a lawfully present immigration status before becoming a citizen. Only those who did not previously have a lawfully present immigration status can take advantage of this qualifying life event.

In addition, new immigrants with an income below the federal poverty level are eligible for premium subsidies. Immigrants aged 65 and older are also eligible for a SEP when they become lawfully present individuals. This is because, prior to the Affordable Care Act (ACA), individual market plans generally did not accept applicants in this age group.

It is worth noting that the ACA's provisions do not apply in US territories, and none of the territories have established their own exchanges. Therefore, someone who becomes a US national must move to a US state to take advantage of the special enrollment period, as ACA-compliant plans are only offered in these locations.

Frequently asked questions