What Is a Qualifying Life Event for Health Insurance?

Obtaining government or private health insurance may seem daunting. The annual open enrollment period is typically from November 1 through December 15, but this may not work with every situation. Thankfully, there are certain circumstances and special enrollment periods that allow you to get health coverage throughout the year.

What is a qualifying life event? A qualifying life event (QLE) is an event that can change your eligibility and allow you to choose a health plan outside of the standard enrollment period. There are four main types of QLEs Read on to learn which life events allow you to enroll for health coverage throughout the year.

Loss of Coverage

There are a few main life changes that cause you to lose your current health insurance plan. If you switch employers or lose your job, you become ineligible for their insurance benefit. This qualifying life event allows you to search for COBRA coverage. If you already have COBRA, but it is running out, you can renew it during a special enrollment period outside of open enrollment.

Once you turn 26, you are no longer able to stay on your parent’s plan. However, this is a QLE where you can seek insurance outside of the open enrollment period. When looking for a new plan, you can choose between public and private insurance and may only need minimum essential coverage.

Changes in Household

Depending on your insurance plan, changes to your household qualify you for a special enrollment period. Notify your insurance carrier as soon as possible if you have any of the following changes in household:

  • Marriage or legal separation
  • Having a baby or adopting a child
  • A death in the family

Changes in the household should not change your deductibles, but be sure to thoroughly review your plan when adding or removing a family member.

A Change in Residence

Moving within your town or city may not qualify you for a special enrollment period. Still, there are specific residence changes that allow you to change your insurance as a qualifying life event. Here are a few:

  • Moving to a different state, county, or zip code
  • A student moving to or from your school
  • A seasonal worker who must move for work
  • Moving to or from transitional housing, like a shelter

If you have changed addresses, you have 60 days to provide legal documentation of your residence change, including a rental agreement, mortgage deed, and valid identification card.

Other Qualifying Life Events

You may become eligible for another QLE that allows you access to health coverage without having to wait for the next open enrollment period. Here is a list:

  • Becoming a U.S. citizen or legal resident
  • Becoming a member of a federally recognized tribe or obtaining shareholder status through the Alaska Native Claims Settlement Act (ANCSA)
  • A significant change in income that changes your qualifications
  • Leaving incarceration
  • Starting or ending an AmeriCorps service

Government Health Plans

Depending on the QLE, you may have different special enrollment periods. Check with healthcare.gov to make sure you stay covered.

There are many reasons why you may qualify for government health care. If your employer does not offer health insurance coverage, you are a freelancer or work for yourself, or are otherwise no longer working; you may be eligible for government insurance.

With the passing of the Affordable Care Act (ACA), you can now shop the health insurance marketplace to get the best coverage for you and your family without a QLE.

Medicare vs. Medicaid

It’s easy to confuse the two, but let’s look at who qualifies for either Medicare or Medicaid.

 If you have recently retired or become disabled, you may qualify for a medicare plan regardless of your income. Medicare is a federal program that provides those over 65 or with a qualifying disability health insurance.

You do not have to wait for open enrollment to apply for Medicare. As long as you are a U.S. Citizen or legal resident, you can enroll anytime within seven months of your birthday – up to three months before your birthday, your birthday month, and up to three months after your birthday. If you are disabled, you are eligible for Medicare after your 25th month of receiving benefits.

Medicaid is available to citizens and legal residents of the United States who make under a certain income, which you can apply for any time throughout the year. Native Americans, Alaska Natives, and children in foster care do not need a qualifying life event to apply for Medicaid.

Children’s Health Insurance Program

Like Medicaid, you can apply for the Children’s Health Insurance Program (CHIP) throughout the year. Visit healthcare.gov to see if your family qualifies for CHIP health benefits and to apply.

Private Insurance

While businesses are not required to provide health insurance coverage to their employees, many offer this benefit to entice quality candidates. Like with the health insurance marketplace, the open enrollment period for private, employer health coverage is in the late fall. However, life changes and qualifying life events allow you to add or remove a family member outside the open enrollment window.

If you are a freelancer or self-employed, you can obtain private health insurance through the health insurance marketplace. There are a few requirements to meet to get private health coverage:

  • U.S. Citizen or legal resident
  • Cannot be incarcerated at the time of enrollment
  • Cannot have medicare coverage

The marketplace offers rates and information on insurance providers available to you to choose the insurance company that best fits your needs.

The Bottom Line

Obtaining the appropriate insurance plan is essential to maintain you and your family’s health. Different plans and service areas may dictate what insurance company you can use, but maintaining coverage will help you in the event of a natural disaster or extreme condition.

Particular circumstances allow you to change insurance plans outside of the open enrollment period. 

So, if you’re asking yourself, “what is a qualifying life event, and how does it affect my insurance plan?” staying on top of QLE requirements will help you know how long you have following life changes to update your insurance policy.