What is considered a qualifying life event?
03/31/2023

What is considered a qualifying life event?
Health insurance is an important aspect of one’s overall health and well-being, as it helps cover the costs of medical care when unexpected health issues arise. In the United States, individuals can typically only enroll in health insurance plans during the annual open enrollment period, usually from November to December. However, certain qualifying life events allow individuals to enroll in health insurance outside this period.
A qualifying life event (QLE) is a major life change that triggers a special enrollment period (SEP), allowing individuals and families to enroll in health insurance coverage outside the regular annual ACA open enrollment period. This period typically lasts 60 days from the qualifying event, allowing individuals to purchase health insurance or make changes to their existing coverage.
Here are some of the most common qualifying life events:
Loss of health coverage: If an individual loses their health insurance coverage due to circumstances beyond their control, such as losing a job, aging out of a parent’s plan, or losing eligibility for Medicaid or CHIP, they may be eligible for a special enrollment period.
Change in household size: If an individual experiences a change in their household size due to marriage, divorce, birth, adoption, or death, they may be eligible for a special enrollment period.
Change in residence: If an individual moves to a new state or their zip code changes due to a move, they may be eligible for a special enrollment period.
Change in income: If an individual experiences a change in income that affects their eligibility for premium tax credits or cost-sharing reductions, they may be eligible for a special enrollment period.
Loss of coverage due to a natural disaster: If an individual loses their health insurance coverage due to a natural disaster, such as a hurricane or wildfire, they may be eligible for a special enrollment period.
Becoming a citizen: If an individual becomes a U.S. citizen, they may be eligible for a special enrollment period.
Leaving incarceration: If an individual is released from incarceration, they may be eligible for a special enrollment period.
Aging off a parent’s plan: If an individual is no longer eligible to stay on their parent’s health insurance plan due to turning 26 years old, they may be eligible for a special enrollment period. It’s important to note that these are just some of the most common qualifying life events, and there may be other circumstances that qualify an individual for a special enrollment
It’s important to note that these are just some of the most common qualifying life events, and other circumstances may qualify an individual for a special enrollment period. The goal of the special enrollment period is to help individuals who experience major life changes gain access to health insurance coverage outside of the regular open enrollment period.
If an individual experiences a qualifying life event, they should act quickly to enroll in health insurance coverage or change their existing coverage. The special enrollment period typically lasts 60 days from the qualifying event date, and it’s important to enroll within this window to avoid a coverage gap.
In conclusion, a qualifying life event is a major life change that triggers a special enrollment period for an individual or family to purchase health insurance outside the annual ACA open enrollment period. The most common qualifying life events include loss of health coverage, change in household size, change in residence, change in income, loss of coverage due to a natural disaster, becoming a citizen, leaving incarceration, and aging off a parent’s plan. If an individual experiences a qualifying life event, they should act quickly to enroll in health insurance coverage or change their existing coverage to avoid a coverage gap.