Understanding Medical Insurance: Qualifying Life Events Explained

A qualifying life event is a life-changing situation that can impact you and your health insurance. These events trigger an open enrollment window for an individual or family to purchase health insurance outside of the annual or scheduled open enrollment periods. Examples of qualifying life events include marriage, divorce, turning 65, loss of other coverage, and changes in income.

Marriage or divorce

If you have experienced a qualifying life event, you may qualify for a Special Enrollment Period (SEP). This is a life-changing situation that can be planned or unexpected and can trigger an open enrollment window for an individual or family to purchase health insurance outside of the scheduled open enrollment periods.

Qualifying life events can include marriage, divorce, or the loss of other coverage. If you lose your insurance, it is considered a qualifying life event. This means if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP).

It is important to note that not all divorces are considered qualifying events, and it depends on whether the exchange or insurer counts it as a qualifying event, or if the divorce triggers a loss of other coverage. Additionally, turns 65 is another moment in time that’s a qualifying life event. It gives you a chance to look into your opportunities to choose a Medicare plan.

Loss of other coverage

If you lose your insurance, it's considered a qualifying life event. This means if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes Medicaid or Children's Health Insurance Program (CHIP) coverage.

If you lose your health insurance, it is considered a qualifying life event. This means that if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes Medicaid or Children's Health Insurance Program (CHIP) coverage.

Qualifying life events include the loss of other coverage, as long as the coverage you’re losing is considered minimum essential coverage.

Qualifying life events include the loss of other coverage, as long as the coverage you’re losing is considered minimum essential coverage.

Qualifying life events include the loss of other coverage, as long as the coverage you’re losing is considered minimum essential coverage.

Qualifying life events include the loss of other coverage, as long as the coverage you’re losing is considered minimum essential coverage.

Change in income

A qualifying life event is a life-changing situation that can impact you and your health insurance. Experiencing a significant life change may allow you to change your health plan outside of the annual enrollment period (also called open enrollment). If you’ve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card for help.

Changes in income that affect your eligibility for Medicaid coverage are considered a qualifying life event. After already having an ACA plan, becoming eligible for tax credits that lower premiums is also a qualifying life event.

For new U.S. citizens, becoming eligible for Marketplace coverage is a qualifying life event. For AmeriCorps VISTA members, beginning or ending service is a qualifying life event.

If you lose your insurance, it's considered a qualifying life event. This means if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes Medicaid or Children's Health Insurance Program (CHIP) coverage.

Turning 65 is another moment in time that’s a qualifying life event. It gives you a chance to look into your opportunities to choose a Medicare plan.

Becoming a U.S. citizen

Qualifying life events include turning 65, marriage, divorce, loss of other coverage, a permanent move to an area where different health plans are available, a change in income that changes your subsidy eligibility, an increase in income that moves you out of the Medicaid coverage gap, a grandfathered or grandmothered plan’s non-calendar-year renewal, and becoming a U.S. citizen or lawfully present resident.

For new U.S. citizens, becoming eligible for Marketplace coverage is a qualifying life event. For AmeriCorps VISTA members, beginning or ending service is a qualifying life event. There are times when an Exceptional Circumstance (also called Special Circumstance) takes place that may qualify a person for a Special Enrollment Period.

Examples of events that qualify for special enrollment include: Having been kept from enrolling during Open Enrollment due to a serious medical condition or a natural disaster (such as a pandemic or hurricane). If someone working in an official capacity prevented enrollment, made a mistake in enrollment, gave wrong information, etc.

If you lose your insurance, it's considered a qualifying life event. This means if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes: Medicaid or Children's Health Insurance Program (CHIP) coverage.

Turning 65

When you turn 65, you can change your health plan outside of the annual enrollment period (also called open enrollment). This is a Special Enrollment Period (SEP).

You can also qualify for SEP if you have experienced any other qualifying life events, such as:

• Earning U.S. citizenship
• Becoming eligible for tax credits that lower premiums
• Becoming a U.S. citizen or lawfully present resident
• Changes in income that affect your eligibility for Medicaid coverage
• If you lose your insurance
• If you are asked to renew or recertify your Medicaid
• Marriage
• Divorce
• A permanent move to an area where different health plans are available
• A change in income that changes your subsidy eligibility
• An increase in income that moves you out of the Medicaid coverage gap
• Having been kept from enrolling during Open Enrollment due to a serious medical condition or a natural disaster
• If someone working in an official capacity prevented enrollment, made a mistake in enrollment, gave wrong information, etc.

If you experience any of these qualifying life events, you’d qualify for a Special Enrollment Period (SEP).

Frequently asked questions