What are Qualifying Life Events?
Key Takeaways
A Qualifying Life Event (QLE) allows you to purchase health insurance or change coverage outside of the Open Enrollment Period for the current plan year.
A special enrollment period follows significant life events like childbirth or adoption, marriage or divorce, unemployment, or unexpected health coverage loss.
The Special Enrollment Period allows you to make changes to your existing coverage or enroll for the first time.
What is a Qualifying Life Event?
There are four main types of qualifying life events: loss of health insurance coverage, household changes, moving and other circumstances. Here are some examples:
Loss of Coverage
- Losing job-based coverage (voluntary or involuntary)
- Losing eligibility for Medicare , Medicaid or CHIP
- Losing insurance through a family member
- Aging off of a parent’s plan at 26
Household Changes
- Getting married
- Getting divorced or legally separated
- Having or adopting a baby
- Death in the family
Moving
- Moving to a different ZIP code
- Moving from outside the U.S.
- Students moving to or from college, or seasonal workers moving to where they live or work
- Moving to or from a shelter
Other
- Gaining U.S. citizenship
- Substantial changes in income
- Errors with an original enrollment
- Leaving jail
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What is a Special Enrollment Period?
If you have a Qualifying Life Event, you are eligible for the Special Enrollment Period. The period allows you to make changes to your current health insurance plan, or add your spouse or children to your health coverage. Your Special Enrollment Period usually starts 60 days [i] from the date of your event, when you can make changes to your existing health insurance coverage.
Are there exceptions to Qualifying Life Events?
There are some “complex issues” [i] that may allow you to buy a medical health plan outside of Open Enrollment.
- Exception circumstances: You experienced a medical condition or natural disaster that prevented you from applying during open enrollment.
- Misinformation or misrepresentation: You enrolled in the wrong plan because of misinformation, misrepresentation, misconduct or inaction from a health insurance company.
- Enrollment error: Your health insurance application was rejected because of missing data or technical issues.
- Medicaid or CHIP exceptions: You were incorrectly advised you were eligible for Medicaid or the Children’s Health Insurance Program (CHIP).
- Domestic abuse victims: You want to enroll in a separate health plan from your abuser. You may be eligible to receive a tax subsidy separately, and your dependents may also be eligible.
If you think you might qualify for special enrollment, GoHealth’s licensed insurance agents can determine your eligibility and help you find and enroll in a health plan that’s right for you.
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