Life can be unpredictable. From getting a new job to adding a new family member, you never know what life has in store for you each year. While surprises can be fun, nobody likes surprises in their health insurance — like price increases, reduced coverage, or being assigned to a new doctor who is too far away.
Luckily, whether you lose coverage or simply don’t like your current plan, you might not have to wait until open enrollment to switch insurance plans when you experience a qualifying life event. In this blog, we’ll explain what a qualifying life event for insurance is and how to get health insurance after open enrollment by proving you’ve experienced a qualifying event.
During Open Enrollment, you can either enroll in a healthcare plan if you do not already have one, or switch plans if you aren’t satisfied with your current health coverage. Open Enrollment typically begins on November 1st for the upcoming year and ends on January 15th of the coverage year. Individuals and families can take advantage of that time to shop and compare plans on the Health Insurance Marketplace, as well as apply for financial assistance.
Open Enrollment was a critical part of the Affordable Care Act (ACA), transforming the way people shop and qualify for health insurance. Before Open Enrollment went into effect, individuals could only switch health insurance plans during a small window of time, when their policy was up for renewal, or during specific life events.
Plus, health insurance companies could deny coverage based on pre-existing conditions or raise rates if you were in poor health. These limitations left many individuals stuck with their unsatisfactory and often overpriced existing coverage out of the fear that switching plans could result in their being denied coverage. Open Enrollment changed everything.
The ACA made it illegal for insurance carriers to deny anyone health insurance coverage due to pre-existing conditions, or to raise rates based on health status. Meanwhile, Open Enrollment gives individuals and families an extended time to compare competitively priced plans and find the one that best fits their health and financial needs.
Thanks to Open Enrollment, if you aren’t happy with your existing plan, you aren’t stuck with it until certain life events occur and you can’t be denied coverage — no matter your health status.
So, what happens if you missed open enrollment and you’re unhappy with your health insurance — or don’t have coverage at all? Don’t worry — you do have options.
If you experience a qualifying life event, you’re eligible for a Special Enrollment Period (SEP), during which you can apply for or switch to a new plan. Keep in mind that you have a limited number of days leading up to or following your qualifying event to enroll. That timeframe varies depending on the qualifying life event (30 or 60 days being standard).
A qualifying event for health insurance purposes is an event that would either cause you to lose coverage, require additional coverage, or be eligible for a change in coverage. Some of these events are planned while others, well, they happen.
Major life transitions, like a change in marital status or adding a family member, and employment status changes account for most qualifying life events. However, types of events are nuanced, and we’ll explore them further below.
Not sure if you’re experiencing a qualifying life event? Health insurance enrollment guidelines can be confusing, so we’ve listed common life changes that could qualify you for a Special Enrollment Period. If you don’t see your current status on this list and believe you’re going through a qualifying life event, contact your employer or call the member services phone number on your insurance card to check your SEP eligibility.
Changes to the number of individuals in your household or their relationships could trigger a SEP. These might include:
As your family continues to grow and evolve, you may need new or additional coverage.
If your or your spouse’s employer offers health insurance, changes in either individual’s employment status could impact coverage eligibility. These changes can include:
One of the benefits of full-time employment is often health insurance. However, that also means that a change in your career circumstances can trigger a change in your healthcare coverage.
There are a few qualifying life events that you can predict because they simply come with age. These include:
If you or a family member is approaching one of these milestone birthdays, plan for the health insurance changes that can accompany them.
Relocating and/or updating your citizenship status can count as a qualifying life event, too. You might need to update your coverage or enroll in a new plan if you:
Fortunately, most individuals have advance notice for these life events, giving you plenty of time to research your health insurance options.
Whether you’ve lost coverage or become eligible for new coverage, there are certain documents you’ll need to present to verify your qualifying life event. The type of event will determine which documents you need to gather.
To help you plan for this transition, we’ve created lists of the documents you’ll need for the associated qualifying life event:
If you don’t have access to the necessary documentation, speak with the insurance company or your employer. They may accept alternative documents or items confirming your qualifying life event.
If you have experienced or anticipate experiencing a qualifying life event, it’s important to know what the next steps are to make sure you’re covered. Time is of the essence because SEPs don’t last forever.
Here’s what you need to apply for health insurance outside of open enrollment:
Need more assistance with the application process? Speak to a benefits administrator at your or your spouse’s place of employment. If you’re shopping through the ACA marketplace, you can call their customer support line at 1-800-318-2596 for guidance.
If you don’t qualify for a SEP, you could still receive health coverage through Medicaid. Designed for low-income individuals, as well as pregnant women, children, and those with disabilities, Medicaid does not require applicants to adhere to any specific enrollment period. However, you do need to meet the eligibility requirements to be approved for coverage. You can review Medicaid’s full eligibility policy to see if you qualify.
Don’t qualify for Medicaid? You still have options — you’ll just have to look outside of ACA plans. These can include:
Some individuals don’t realize they qualify for a SEP. For example, you could qualify for domestic partnership benefits, even if you aren’t married. If you and your partner live together and can prove financial dependence, you might be eligible for health insurance through their provider.
Our helpful AI assistant can help evaluate your situation to determine whether or not you qualify for a SEP.
Insurance ‘N You can help you find quality healthcare coverage at competitive prices. We’re here to remove the mystery of understanding your health insurance options.
With powerful tools like our AI assistant and digital wallet, we’re ready to provide instant answers to all of your health insurance questions, from what your policy covers to where your nearest in-network provider is. We believe that you deserve transparency in your health insurance shopping journey.
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We’re all about providing you with the answers you need to apply for the best possible coverage, when you need it.
Yes, turning 26 is a qualifying life event because anyone older than 25 is no longer covered under their parents’ health insurance.
No, pregnancy is not considered a qualifying life event. However, giving birth is, because you are adding a member to your family who will require new coverage.
Moving can be a qualifying life event if you move to an area that is not covered by your previous insurance plan.
Yes, quitting a job is a qualifying life event. Loss of employment for any reason — voluntary or not — makes you eligible for a SEP.
We do not recommend dropping your health insurance without a qualifying life event, as it will leave you without coverage until the next open enrollment period. You might also face costly tax penalties for going without coverage.
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