Qualifying Life Event For Health Insurance

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Jessica Fox 29-10-2021

Understanding Qualifying Events For Health Insurance

qualifying events for health insurance

We know that the best time to get health insurance is during Open Enrollment. However, certain circumstances or “qualifying life events” permit you to get coverage outside the standard enrollment period.

Not every event is considered a qualifying life event, so read on, and we’ll cover all the instances when you can access a Qualifying Open Enrollment Period.

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What Is A Qualifying Life Event?

Under normal circumstances, to purchase or make changes to your health insurance plan, you must do it during Open Enrollment. However, circumstances or qualifying events allow you to buy a life insurance policy or change your existing policy beyond the Open Enrollment Period window. 

Which Health Insurance’s Permit Qualifying Life Events?

Not all health insurance providers recognize qualifying life events. For example, ACA-compliant medical plans recognize qualifying life events such as marketplace, group coverage, or semi-compliant grandfathered plans.

However, if you experience a qualifying life event, short-term medical plans won’t allow you to make changes to your coverage.

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What Is Considered a Qualifying Life Event?

Now that we know what qualifying life events are, let’s look at specific examples.

  • Loss Of Health Coverage: If you lose your health insurance for any of the below reasons, you can buy ACA-compliant coverage outside of Open Enrollment.
    • If you lose group coverage, COBRA or student health insurance
    • If you turn 26 and lose coverage from under your parents
    • Loss of eligibility through Medicaid, Medicare or Children’s Health Insurance Program (CHIP)
    • Loss of health insurance, apart from not paying premiums
  • Change In Household: If your household changes, then it’s grounds for a policy adjustment. Some examples of qualifying events are:
    • Having or adopting a baby
    • Marriage or divorce
    • Someone passing away that’s on your health insurance
  • Residency Change: Those individuals who change their address for any of the below reasons can call and make changes to their policy coverage.
    • If you’re moving to a different zip code or country
    • Students going away or coming home from school
    • If you’re a seasonal worker that’s going to or leaving from their work location
    • If you’re going to or leaving a transitional house, like a shelter
    • If you’re moving to the United States
  • Other: Other circumstances that warrant you to adjust your health coverage, are:
    • Income changes that alter your Medicaid eligibility
    • If you have an ACA plan and your eligibility for tax credits changes
    • If you’re a member of a tribe recognized by the federal government
    • If you’re new to the United States
    • Beginning or ending service for AmeriCorps VISTA members
    • Released from incarceration

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Qualifying Life Events And Special Enrollment Periods

When you experience a qualifying life event, it triggers a Special Enrollment Period that lasts 60 days after your event. The Special Enrollment Period (SEP) is what grants policyholders access to their ACA-compliant health insurance.

Be sure to make changes within the 60-day window; otherwise, you’ll lose the opportunity to access ACA-compliant health plans. Although, you can still apply for Medicare (if applicable) or purchase health coverage through insurance.

Proving Your Qualifying Event

In order to be eligible to make changes to your health insurance, you still need proof of your claims — documentation — that you can give to your insurer. 

How it works is you’ll pick your health insurance policy (or make changes), and then you must get the documentation to your provider within 30 days. However, your policy will not come into effect until after you’ve paid your premium, your eligibility is confirmed, and your qualifying event is confirmed.

Cancelling Health Insurance Without A Qualifying Event

It’s important to note that you don’t need a qualifying life event to cancel your health insurance coverage. However, bear in mind that if you cancel your plan, you can’t enroll until the next Open Enrollment period.

Unfortunately, group coverage requires you to have a qualifying life event to cancel your coverage; or you’ll face tax penalties under section 125 of the Internal Revenue Code.

Qualifying Life Event For Health Insurance

You never want to be without health insurance, so it’s important to know the special circumstances that allow you to access your ACA-compliant health plan if you need to make adjustments to your policy.

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Jessica FoxJessica Fox has been a freelance writer for five years, with a specialty in health, wellness, and insurance. During this time, she’s written for some of the biggest B2B and B2C brands from around the world. Jessica is also the mother of two young daughters and loves coffee, writing, and working out.