What Is a Qualifying Life Event?

How Qualifying Life Events Work

You can sign up for and make changes to your health plan every year during open enrollment. However, you can also shop for a health plan outside of that window of time—but only if you have a qualifying life event (QLE).

These events can include getting married, having a child, or losing your current health insurance coverage. You have a special time during which you can make changes to your health plan after one of these events.

You may be asked to prove your eligibility for a special period and for a copy of your denial letter if you're trying to apply because Medicaid or the Children's Health Insurance Program (CHIP) turned you down. A judge's order will be necessary if you gain a dependent through a court process.

These types of proof are required within 30 days of picking a plan in most cases. The insurer will send you notices about your status and any rules you haven't yet met or proof that you haven't yet sent in.

Example of a Qualifying Life Event

An example of a qualifying life event is when a young adult who is covered under their parent's healthcare plan turns 26 years old. At this point, the parent would no longer be able to extend healthcare coverage for their son or daughter, and they would need to get coverage on their own. However, turning 26 is considered a qualifying life event.

As a result, the 26-year-old would not have to wait until the open enrollment period, which typically runs from Nov. 1 to Jan. 15 the following year, to obtain health insurance.

Types of Qualifying Life Events

Qualifying life events usually revolve around changes in your job, location, income, or family status. Some of the qualifying events include the following:

A change in household size is a qualifying life event, which includes marriage, divorce, having a baby or adoption, the death of a family member, and family changes ordered by a court.

Changing your residence or where you live could also qualify, which could include if you're a student and move to school or moving to a new state or county.

Loss of your old health insurance coverage also qualifies, either 60 days in the past or 60 days into the future. This includes loss of insurance from work or as a student. Also, if you lost your eligibility for Medicare, CHIP, or Medicaid, you can file for a qualifying life event.

Non-Qualifying Life Events

A qualifying life event is a life-changing circumstance that impacts your health plan. A change might not qualify if it doesn't affect your plan. A divorce or the loss of a family member won't get you a special enrollment period if it doesn't change your plan's coverage in any way.

Other events that don't count include moving just for a short time, voluntarily dropping your current health plan, or having your plan canceled for non-payment.

More Complex Issues

Some changes may qualify you for a special period, even if they don't involve a change in family size, location, or your job. You may have endured domestic abuse or violence or faced a medical condition or natural disaster during an enrollment period, making you unable to enroll.

Alternatives to Qualifying Life Events

You can look into applying for Medicaid or the Children's Health Insurance Program (CHIP)—which always accepts applications—if you don't qualify for special enrollment. You might also look into membership health insurance or a temporary health plan.

Membership health insurance can be obtained if you belong to an organization that provides it. If you're a student, see whether your school offers a student health plan if you're enrolled in a higher education program.

A short-term health plan can help in the event of a catastrophic event, but it might not be a good long-term option, because coverage is often just minimal.

Frequently Asked Questions (FAQs)