Qualifying Life Events: Canceling Health Insurance

A qualifying life event is a significant change in your life situation that allows you to change your health insurance plan outside of the standard annual enrollment period. These events typically include circumstances that may impact your current health insurance coverage and necessitate enrolling in a new plan. Examples of qualifying life events include gaining or losing dependents, changes in employment status, moving to a new area, and changes in income that affect your eligibility for certain coverage. It's important to note that the specific qualifying life events may vary depending on the type of health insurance plan and the state you live in.

Loss of health coverage

Losing your health coverage is a qualifying life event that allows you to make changes to your health insurance plan. This includes losing your job and employer-sponsored insurance, losing your eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP), and turning 26 and losing coverage from your parent's health plan.

If you lose your job-based health insurance, you have two main options: enrol in a plan through the Health Insurance Marketplace or sign up for COBRA coverage. If you choose to enrol in a Marketplace plan, you will qualify for a Special Enrollment Period to get coverage for the rest of the year. You need to apply for Marketplace coverage within 60 days of losing your job-based coverage, and your coverage can start the first day of the month after you lose your previous coverage. You may also need to provide proof that you lost your job-based coverage.

If you choose to sign up for COBRA coverage, you can keep your job-based health plan for a limited time after your job ends, usually 18 months. You will typically pay the full premium yourself, plus a small administrative fee.

If you lose your health coverage, you may qualify for a Special Enrollment Period to enrol in a new health insurance plan or change your existing plan outside the Open Enrollment Period. This period typically lasts 60 days before or after a qualifying life event. To enrol in a new plan, you may be required to provide documentation of your qualifying life event, such as divorce paperwork or a death certificate that shows a family member who had previously provided you with health insurance coverage.

If you are unsure whether you qualify for a Special Enrollment Period, you can contact your insurer or the Marketplace to discuss your options.

Change in residence

A change in residence is a qualifying life event that can impact your health insurance coverage. Moving to a new location may change the insurance options available to you, and this could include moving to a different zip code, county, or state that changes your health plan area. This change in residence could also be moving to or from a place of education, seasonal work, or transitional housing.

If you have moved or are planning to move, it is important to contact your insurer or the Marketplace to understand your coverage options and avoid a gap in coverage. You may be required to provide documentation of your move, such as new rental agreements, deeds, or mortgages, to show that you have moved into a new health insurance plan area.

In the United States, a Special Enrollment Period (SEP) allows you to apply for essential health insurance coverage 60 days before or after a qualifying life event, such as a change in residence. This is the only time outside of the Open Enrollment Period when you can typically sign up for a new health insurance plan or change an existing one.

If you do not meet the qualifications for an SEP, there are still options for coverage, such as enrolling in Medicaid, a government-run health insurance program for low-income individuals, children, pregnant women, and people with disabilities.

Change in household

Changes in household are one of the four basic types of qualifying life events (QLE) that can impact your health insurance coverage. These 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. Here are some scenarios that can be classified under "change in household" as a qualifying life event:

Getting Married or Entering into a Partnership

Marriage or the formation of a domestic partnership is a qualifying life event that can impact your health insurance options. You may choose to be added to your spouse's or partner's health insurance plan or vice versa. This change in household composition allows you to modify your health insurance coverage accordingly.

Having a Baby or Adopting a Child

The addition of a dependent, either through birth or adoption, is a significant change in your household. This event may prompt you to adjust your health insurance plan to ensure that your child receives the necessary coverage.

Divorce or Legal Separation

If you were previously covered as a dependent under your spouse's health insurance plan and are now going through a divorce or legal separation, you will need to make changes to your health insurance coverage. This may involve removing your former spouse from your plan or finding alternative coverage if they were the primary policyholder.

Death of the Primary Policyholder

In the unfortunate event of the death of the primary policyholder in the family, a change in household composition occurs. This qualifying life event necessitates adjustments to the health insurance plan, as the remaining family members will need to transition to a new plan or modify their existing coverage.

It is important to note that these are just a few examples of changes in household circumstances. Other scenarios, such as a dependent child reaching the age of 26 and losing coverage under their parent's plan, can also be considered qualifying life events. If you believe you have experienced a significant change in your household that may impact your health insurance coverage, it is advisable to consult with your health insurer or the Marketplace to explore your options and understand any documentation requirements for eligibility.

Change in income

A change in income is a qualifying life event that can impact your health insurance coverage. This typically refers to changes in income that affect your eligibility for Medicaid coverage. For example, if your income decreases and you meet certain income thresholds, you may become eligible for Medicaid, a government-run health insurance program for low-income individuals and families.

Medicaid eligibility is based on income and other factors such as family size, and it provides essential health coverage for those who cannot afford private insurance. If your income increases and you no longer meet the eligibility requirements for Medicaid, this change in income would also be a qualifying life event, allowing you to transition to a different health insurance plan outside of the annual Open Enrollment Period.

In the context of health insurance, a qualifying life event (QLE) is a significant change in your life circumstances that impacts your insurance needs. These events generally fall into different categories: loss of health coverage, changes in your household, changes in residence, and changes in your income.

It's important to note that the impact of a change in income on your health insurance will depend on the specific plan and your location. Different states and insurance providers may have varying criteria for determining eligibility based on income. Therefore, it's always a good idea to consult with your health insurer or the relevant government agency to understand how a change in income might affect your coverage options.

Additionally, when enrolling in or changing your health insurance plan due to a qualifying life event, you may be required to provide documentation supporting the change in income. This could include tax returns, pay stubs, or other financial records.

Change in citizenship status

Changes in citizenship status can be considered a qualifying life event (QLE) that allows you to change your health insurance plan outside of the yearly Open Enrollment Period. This is referred to as a Special Enrollment Period (SEP).

Qualifying life events are significant life changes that impact your current health insurance coverage and make it necessary to enrol in a new plan. These events typically fall into different categories, including loss of health coverage, changes in your household, and changes in residence.

Becoming a U.S. citizen, U.S. national, or lawfully present individual is a qualifying life event that triggers a 60-day special enrollment period. This means that once you gain citizenship, you have 60 days to enrol in a health insurance plan through the exchange.

It is important to note that a special enrollment period does not apply if you already had a lawfully present immigration status before becoming a citizen. Any change in immigration status that triggers a special enrollment period must be from a status where the individual did not previously have a lawfully present immigration status.

Documentation for Change in Citizenship Status

When enrolling in a plan after a change in citizenship status, you may be required to provide documentation. The type of documentation needed depends on the specific event and can vary, but it is important to be prepared and have the necessary documents ready.

Other Qualifying Life Events

In addition to changes in citizenship status, other examples of qualifying life events include:

• Losing existing health coverage
• Losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP)
• Turning 26 and losing coverage from a parent's health plan
• Changes in household status, such as getting married, having a baby, or adopting a child
• Changes in residence, such as moving to a different zip code or state

Frequently asked questions