Life Events: Understanding Insurance Coverage And Your Policy

A qualifying life event (QLE) is a significant change in an individual's life that allows them to enroll in or make changes to their health insurance benefits outside the normal open enrollment period. QLEs can include events such as marriage, divorce, moving to a new area, and the birth or adoption of a child. These events typically fall into four basic types: loss of health coverage, changes in household, changes in residence, and other qualifying events. For example, if an individual loses their health insurance, they can qualify for a Special Enrollment Period (SEP) to sign up for a new plan or change their existing one. Similarly, changes in household composition, such as getting married or having a baby, can trigger a SEP. Moving to a different location, whether it's a new zip code or a foreign country, can also initiate a SEP. Other life events, such as changes in income, gaining U.S. citizenship, or leaving incarceration, may also qualify individuals for a SEP.

Loss of health insurance

Losing your health insurance is a significant life event that can impact your health insurance coverage and make it necessary to enroll in a new plan. This is known as a qualifying life event (QLE) and allows you to apply for a Special Enrollment Period (SEP).

A QLE is a change in your situation that can make you eligible for an SEP, allowing you to enroll in health insurance outside of the yearly Open Enrollment Period. The Open Enrollment Period is an annual period, usually from November 1 to January 15, when individuals and families can purchase a health plan through the Health Insurance Marketplace.

During an SEP, you can apply for essential health insurance coverage 60 days before or after a QLE. Losing your health insurance is considered an involuntary loss of coverage and is a qualifying event for an SEP. This includes losing your existing coverage, such as job-based, individual, or student plans, and losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).

If you lose your health insurance, you may qualify for an SEP to enroll in a new health plan or change your existing plan outside of the Open Enrollment Period. It is important to plan ahead and contact your insurer or the Marketplace to understand your coverage options and any documentation you may need to provide.

Changes in household

Getting Married

Marriage is a common life event that can impact an individual's health insurance needs. When you get married, your spouse may become eligible for coverage under your existing plan, or you may need to add them as a dependent. This is a qualifying life event that allows you to make changes to your health insurance plan.

Getting Divorced or Separated

Divorce or separation can also impact your health insurance situation. If your spouse was previously covered under your plan, they may lose eligibility for coverage, requiring you to make changes to your plan. Additionally, you may need to remove them as a dependent from your insurance.

Having a Baby or Adopting a Child

The birth of a baby or the adoption of a child is another significant household change that qualifies you to adjust your health insurance plan outside of the Open Enrollment Period. This allows you to add your new family member to your plan and ensure they have the necessary coverage.

Death of a Family Member on the Health Insurance Policy

Experiencing the death of a family member who was on your health insurance policy is a tragic event that can also be a qualifying life event. This may result in changes to your coverage needs, especially if the deceased was the primary policyholder.

Other Household Changes

Other household changes that may qualify you for a Special Enrollment Period include fostering a child, gaining or losing a dependent due to a court order, or experiencing domestic abuse or spousal abandonment and enrolling in a new, personal health policy.

Changes in residence

A change in residence is considered a QLE when it impacts the insurance options available to you. This typically involves relocating to a different zip code, county, or state, which changes your health plan area. For example, you may move to a location where your current insurance coverage is not available, or where new plans are offered that you may want to consider.

Examples of Changes in Residence that Qualify for a Special Enrollment Period:

• Moving to a different zip code or county
• A student moving to or from the place they attend school
• A seasonal worker moving to or from the place they both live and work
• Moving to or from a shelter or other transitional housing
• Moving to the US from a US territory or a foreign country

Documentation for Changes in Residence:

When enrolling in a new plan or making changes to an existing plan due to a change in residence, you will likely be required to provide documentation to confirm the qualifying life event. This may include:

• Proof of residency from new and old addresses
• New rental agreements, deeds, or mortgages
• A driver's license or state identification card
• Official school documentation, including enrollment or housing information
• A letter from your employer confirming that you relocated for work
• A Green Card, education certificate, or visa if you moved to the US from another country

Changes to your eligibility

Changes in Income

If your income changes, it may affect your eligibility for Medicaid coverage. For example, if your income increases, you may no longer be eligible for Medicaid, while a decrease in income could make you eligible.

Tax Credits

If you already have an ACA plan and become eligible for tax credits that lower your premiums, this can be considered a qualifying life event.

Tribal Membership

Becoming a member of a federally recognized tribe is a qualifying life event.

Marketplace Coverage Eligibility

If you are a new US citizen, you may be eligible for Marketplace coverage.

AmeriCorps VISTA Membership

If you are an AmeriCorps VISTA member who is beginning or ending their service, this can be considered a qualifying life event.

Military Service

Being discharged from the military can impact your insurance eligibility and is considered a qualifying life event.

Incarceration

If you are released from incarceration, you may be eligible for a Special Enrollment Period.

Other qualifying events

Qualifying life events (QLEs) are not limited to the categories of losing health coverage, changes in household, and changes in residence. There is an "Other" category that covers a wide range of events, including:

• Changes in income that affect the coverage you qualify for. For example, changes to your income may affect your eligibility for Medicaid coverage.
• Changes in citizenship status, such as gaining U.S. citizenship or becoming eligible for Marketplace coverage.
• Changes in membership status, such as gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
• Changes in employment status, such as starting or ending service as an AmeriCorps member, being discharged from the military, or being released from incarceration.
• Changes in marital status, such as getting married, divorced, or legally separated.
• Changes in address, such as moving to a new area or a different zip code or county.
• Changes in family composition, such as having or adopting a baby, or experiencing the death of someone on your health insurance policy.

It is important to note that the specific requirements and documentation needed to verify a QLE may vary depending on the individual's plan and insurance provider. Therefore, it is always recommended to consult with your insurance provider or the relevant government agency to understand the specific requirements and documentation needed for your situation.

Frequently asked questions