An Overview of Qualifying Life Events and Health Insurance Enrollment

September 16, 2024 | 6 min read

For all types of health insurance, there are generally two opportunities to enroll and activate coverage. The first is during an open enrollment period. On the Health Insurance Marketplace, open enrollment occurs from Nov. 1 to Jan. 15. During the rest of the year, you can get health insurance, or make a change to your current plan, if you experience a qualifying life event, which gives you a special enrollment period.

What is a Qualifying Life Event?

A qualifying life event is a change in your circumstances, such as losing a job or having a baby. Because these kinds of major life events can alter your health insurance needs, they are considered qualifying life events. They enable you to be eligible for a special enrollment period, during which you can choose a new insurance plan or make changes to your current coverage. You don’t have to wait for the yearly open enrollment.

List of Qualifying Life Events

There are generally four types of circumstances that may be considered qualifying life events.

1. Loss of existing health coverage. This includes job-based, individual, and student plans as well as:

Losing eligibility for Medicare, Medicaid or the Children’s Health Insurance Program (CHIP)
Turning 26 and losing coverage through a parent’s plan

2. Changes in household. Examples include:

Getting married or divorced
Having a baby or adopting a child
Loss of a family member due to death

3. Changes in residence. In addition to moving to a different ZIP code or county, it could also include:

Students moving to or from the place they attend school
Seasonal workers moving to or from the place they live and work
Moving to or from a shelter or other transitional housing

4. Other qualifying events. These may include:

Changes in your income that affect the coverage you qualify for
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becoming a U.S. citizen
Leaving incarceration (jail or prison)
AmeriCorps members starting or ending their service

These are just some of the situations that make the list of qualifying life events. If you are not sure if you qualify or need more information, you can learn more about qualifying life events or get help from our Ambetter Health team at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET.

Documenting Your Qualifying Event

When you apply for Marketplace insurance due to a life event, you may need to provide documents to confirm your event and show that you qualify for a special enrollment period. The types of documents required will vary based on your qualifying event.

For example, if you lost health insurance coverage due to job loss, you may have to provide the separation letter from your employer. Or if you’ve added a family member, you may need to provide a birth certificate or adoption records.

To get started, choose the plan that’s right for your needs. After you select a plan, you will have 30 days to send documents – if they’re required.

If you recently experienced or are about to experience a qualifying event, you can enroll in a new health plan that meets your needs right away. Browse Ambetter Health plans and apply for the coverage that suits you best.

You can also contact our knowledgeable Ambetter Health team at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET to learn more about your health insurance options. Our licensed agents can help you find the right plan for your unique needs.

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Frequently Asked Questions About Qualifying Life Events

Turning 26 is a qualifying event because parents are only allowed to provide insurance coverage for their children through the age of 26. When the coverage officially ends could vary, so you may need to check with the employer or the insurance plan. Some states and plans have different rules.

In addition, Marketplace plans may differ from most job-based plans. For example, if a child is covered under a parent’s Marketplace plan, the child can maintain coverage through the end of the year during which the child turns 26. So if a child turns 26 on Jan. 1, the child can stay on the parent’s Marketplace plan through Dec. 31 of the same year. However, if a child is covered under a parent’s job-based health insurance, that coverage usually ends on the child’s 26th birthday.

Learn more about how to get your own health insurance coverage when you turn 26.

Yes. If you recently got married, you are eligible for a special enrollment period.

However, if you got divorced or legally separated, you may be eligible for a special enrollment period only if you lost health insurance as a result of the divorce or separation. If you did not lose your coverage, you will not be eligible for a special enrollment period.

Pregnancy is not considered a qualifying life event, but childbirth is. If you don’t currently have medical insurance and don’t qualify for a special enrollment period during your pregnancy for another reason, you’ll be eligible to apply within 60 days of giving birth.

Typically, you have 60 days from the time of your qualifying event to enroll in a Marketplace health insurance plan.

Learn more about special enrollment periods. If you qualify, our easy-to-use enrollment system will walk you through the process and help identify savings opportunities.

You can also contact our licensed agents at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET to learn more about your health insurance options.

Sources:

HealthCare.gov: Qualifying life event (QLE)

HealthCare.gov: Submit documents to confirm your move

CMS.gov: Understanding Special Enrollment Periods

Healthcare.gov: Special enrollment periods

Healthcare.gov: Special Enrollment Period (SEP)