Open Enrollment Isn’t the Only Time: Qualifying Life Events Explained
Open Enrollment Isn’t the Only Time: Qualifying Life Events Explained
Health insurance is often associated with Open Enrollment—the time of year when individuals can sign up for or make changes to their coverage. But life doesn’t always wait for November. Fortunately, there are circumstances known as Qualifying Life Events (QLEs) that allow individuals to enroll in or change their health insurance outside of the standard enrollment window.
What is a Qualifying Life Event?
A QLE is a significant change in life circumstances that impacts your health insurance needs. These events open a temporary window called a Special Enrollment Period (SEP), during which you can enroll in a new plan or adjust your current one. Common qualifying events include:
∙Marriage or divorce
∙Having a baby, adopting a child, or placing a child for adoption
∙Losing other coverage (such as employer-based insurance, Medicaid, or COBRA)
∙Moving to a new area with different coverage options
∙Turning 26 and aging off a parent’s plan
∙Death of a covered family member
∙Change in immigration or citizenship status
These events must be reported promptly, as the opportunity to make changes is limited.
How Long Do You Have to Act?
After experiencing a QLE, individuals typically have 60 days to enroll in a new plan or make updates to their existing coverage. If action isn’t taken during this window, the chance to change your plan may be lost until the next Open Enrollment period, which could leave you uninsured or improperly covered.
Coverage Options Available
Depending on the nature of the QLE, a variety of coverage options may be available:
∙Marketplace Plans: The Health Insurance Marketplace allows for enrollment during a
SEP triggered by a QLE. Subsidies may also be available based on income.
∙Employer Plans: If the event involves a job change or marriage, individuals may be
eligible to join an employer-sponsored plan—either their own or their spouse’s.
∙Medicaid and CHIP: These programs are open year-round and are often ideal for those
with limited income or new dependents.
Need Help Navigating a Life Change?
Major life changes can be overwhelming, especially when health insurance is involved. If you’ve recently experienced a QLE and aren’t sure where to start, reach out today to explore your options and ensure you stay protected with the right coverage for your new circumstances.