What Is a Qualifying Event for Special Enrollment?

Individual and Family

What Is a Qualifying Event for Special Enrollment?

Published on January 03, 2019

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Whether you’re buying it for your family or just yourself, it’s essential that you jump through all the necessary hoops when purchasing health insurance. That starts with buying health insurance at the right time—the Open Enrollment Period.

What is a qualifying life event?

Under the Patient Protection and Affordable Care Act, most people are required to get their insurance during the Open Enrollment Period, which typically comes at the end of each year. If you have a qualifying life event, you may be eligible for a special enrollment period outside of the ordinary OEP. Keep reading to see what counts as a qualifying life event (QLE), and watch this video to get an overview of QLEs and special enrollment periods.

The loss of coverage

If you find yourself suddenly without health insurance, there is a good chance that you’ve experienced a qualifying life event that could trigger a special enrollment period. Some of the reasons for loss of coverage that usually count as qualifying life events include:

  • Turning 26– The Affordable Care Act allows children to remain on their parents’ insurance until they reach the age of 26. This means that when they turn 26, many children lose their coverage. They are thus eligible for a special enrollment period to get coverage for themselves.
  • Losing Program Eligibility– Public programs like Medicaid and SCHIP provide health insurance to individuals and families that cannot afford it themselves. If you currently rely on one of these programs but your income increases, you may become ineligible. In this case, you can use a special enrollment period to buy insurance without government assistance.
  • Losing Your Source of Coverage– Most working people get their insurance from their jobs, and many students get it from their schools. Thus if you lose your job, graduate, or drop out of school, you need a special enrollment period to replace that coverage.

If you find yourself suddenly without health insurance, make sure to find out if you qualify for a special enrollment period. Loss of coverage for various reasons will often trigger a special enrollment period, except for when it’s due to loss of coverage.

Domestic developments

In addition to developments that directly cause you to lose coverage, there are events within your household that affect the amount of coverage you must buy and how much you have to pay for it. These include:

  • Marriage & Divorce– The beginning or end of a marriage often counts as a qualifying life event.
  • Having Children– Whether you have a baby or adopt a child, you’ll need to provide insurance for them, so this life event usually counts as a qualifying life event, resulting in a special enrollment period.
  • Death– If someone in your family dies, you’ll lose the need to cover them, but you also won’t have their income to help pay for coverage. For these reasons, the death of someone you share a health insurance plan with can count as a qualifying life event.

Whenever your household changes, think about how that change will affect your health insurance. It’s likely that major events in your household—like gaining or losing a member—will result in a special enrollment.

Residency shifts 

Health insurance regulations and availability vary from state to state and even from county to county. Thus if you move anywhere in a different county or with a different zip code, you’ll probably be able to count this change as a qualifying life event. You can also qualify for special enrollment if you’re a seasonal worker moving between your permanent home and your work, a student moving between school and home, or someone moving in or out of transitional housing.

Other qualifying life events 

Some more qualifying life events include:

  • Becoming a member of a Federally-recognized indigenous tribe
  • Becoming a shareholder for the Alaska Native Claims Settlement Act Corporation
  • Experiencing any change in income that alters your eligibility for coverage
  • Beginning or ending service with AmeriCorps
  • Gaining US citizenship or another form of lawful status you didn’t have before
  • Becoming eligible or ineligible for subsidies under the Affordable Care Act
  • Getting out of jail or prison

Whether you experience any of these qualifying life events or are signing up during the open enrollment period, eHealth is committed to helping you get the coverage you need at a price you can afford. For more information on health insurance laws and options, visit our website today.

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