What’s considered a qualifying life event? | Special Enrollment Periods

You need health insurance. You’ve spent time comparing your options online, found the perfect plan, and are ready to start the enrollment process. However, depending on the time of year, you may or may not be able to enroll. During the annual Open Enrollment Period (Nov 1st–Dec 15th), anyone can enroll in a new health insurance plan. But outside of Open Enrollment, you can only enroll if you’ve experienced a qualifying life event.

So what’s considered a qualifying life event (QLE)?

It’s a major event in your life — like losing your health insurance, adopting a baby, or getting married — that makes you eligible for a Special Enrollment Period. When this happens, you’re able to enroll in health insurance outside of Open Enrollment.

What are the different types of Qualifying Life Events?

Losing your health insurance

  • Losing coverage through your employer
  • Losing coverage through a divorce or legal separation
  • Losing coverage through a family member
  • Turning 26 and aging out of your parent’s health insurance
  • Losing your COBRA coverage
  • Losing your coverage through Medicare, Medicaid, or CHIP
  • Losing a health insurance plan you bought yourself

Changes in your household size

  • Getting married
  • Having a baby or adopting a child
  • Placing a child in foster care
  • Losing coverage through a divorce or legal separation
  • Losing coverage due to a death of a family member

Changes in your residence

  • Losing coverage when moving to a new county or ZIP code
  • Losing coverage when moving to or from the place you attend school
  • Losing coverage when moving to or from transitional housing
  • Losing coverage as a seasonal worker when moving to or from the place where you both live and work
  • Moving to the United States from a foreign country or United States territory

Additional qualifying life events

  • Starting or ending your service as an AmeriCorps VISTA member
  • Leaving jail or prison
  • Becoming a U.S. citizen
  • Becoming an Alaska Native shareholder
  • Joining a federally recognized tribe

You can also find a list of additional, complex qualifying life events here.

How long does a Special Enrollment Period last?

Typically, you have 60 days following the event to enroll in a new health insurance plan. However, it varies depending on the type of qualifying life event.

If you get married, have a baby, adopt a child, go through a divorce, or get released from incarceration, you have to enroll the day of or up to 60 days after the QLE. If you experience any other QLE, you can enroll 30 days prior or 60 days after the event.

It’s also important to remember, if you don’t enroll during your SEP, you may have to wait until the following Open Enrollment Period to apply.

I’m ready! How do I enroll in a new health insurance plan?

If you think you’ve experienced a qualifying life event, our Consumer Advocate team can help you enroll in a new plan. You can call us directly at (855) 772-2663. Otherwise, head over to HealthSherpa.com and enter your zip code to easily self-enroll.

HealthSherpa

HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance.

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