7 Qualifying Life Events for Health Insurance
Key takeaways:
Qualifying life events are changes that allow you to enroll in a new health insurance plan or modify your coverage outside the standard enrollment period.
Some examples of qualifying life events include marriage, job loss, and having a baby.
It's important to understand the timeline and documentation required for reporting a qualifying life event to avoid a lapse in coverage.
Generally, you can only make changes to your health insurance plan during the annual open enrollment period. However, certain life changes allow you to adjust coverage outside of the open enrollment period. These are called qualifying life events.
What happens when you have a qualifying life event?
When a qualifying life event occurs, it will open up an eligibility period during which you can make changes to your health plan. You can either sign up for health insurance or add a qualifying family member to your plan during this time.
If you fail to make changes during a qualifying life event’s eligibility period, you may have to wait until the next open enrollment. That could be up to 11 months away, leaving you uninsured during that time. It’s important to be aware of what qualifying life events are and the actions and paperwork required on your end to make coverage changes.
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7 Qualifying Life Events for Health Insurance
Qualifying life events give you a chance to make adjustments to your health insurance plan. Below, we will discuss seven that you should know about.
Loss of health coverage
Losing eligibility for Medicare, Medicaid, or CHIP
Changes to your family
Your 26th birthday
Change of residence
Job changes
Less common circumstances
Here’s what you need to know about various qualifying life events, how they affect your healthcare coverage, and what you need to do when they happen.
1. Loss of health coverage
If you or someone in your household loses healthcare coverage, you may be eligible for a new plan. You may be able to change your coverage if your plan was provided by any of the following:
An employer
A student plan
Your parents
Your own individual plan
What you need to provide
You’ll need to provide documentation that prior coverage has ended in the past 60 days or will end in the next 60 days. However, if you lost coverage after January 1, 2020 but missed the deadline owing to COVID-19, you may still qualify for special enrollment. To apply for health insurance after a qualifying life event, you may need to show any of the following, depending on the reason you lost coverage and your insurer:
Letter from your previous insurance company
Letter from an employer
Documentation of previous COBRA coverage with start and end dates
Documentation showing that you lost coverage owing to the death of a family member.
All documentation must include the date coverage ended or will end.
2. Losing eligibility for Medicare, Medicaid, or CHIP
Eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) is based on income. If your income increases above the eligibility threshold or your family status changes, you may no longer meet the requirements.
Eligibility is determined in relation to the federal poverty level (FPL), which varies by state. Income requirements typically change every year. For example, during 2023, a family of four with children under 19 would need to have an income below $42,660 to qualify for this coverage. If either of those things changes — for instance, if a child turns 20 or the family’s income goes up — they may lose eligibility. These are considered qualifying life events. If one of these events happens, you will be allowed to enroll in a new health plan outside of the annual open enrollment period.
What you need to provide
You’ll need to gather documentation from your state’s Department of Health and Human Services. It should indicate the reason you lost eligibility and when your coverage ended or will end. You may also need to provide proof of income.
3. Changes to your family
The size and structure of families often changes, whether because of marriage, divorce, retirement, or the addition of a child. There are many family-related life events that may qualify you for a special enrollment period. Some of the most common include:
Getting married
Before starting your new life as a married couple, contact your health insurance provider. This will help you understand what documentation is required to add your spouse to your plan. In most cases, you’ll need to provide a copy of the marriage license as proof that your spouse qualifies for coverage.
Children
Whether you have a new baby, adopt, have a new foster child, or blend a family that includes children under age 26, growing your family is a qualifying event. Still, you’ll need to provide proof of the event. This often consists of the following:
A birth certificate or application for a birth certificate
An adoption record, decree, or placement letter
A legal guardianship document
A court order or child support order
Divorce
Losing coverage because of a divorce or needing to remove a former spouse from your plan are situations that qualify you to change your coverage. You’ll need to provide a copy of your divorce, legal separation, or annulment papers. These documents should include the end date of healthcare responsibility and proof of prior qualifying health coverage within the last 60 days.
Loss of a loved one
If the person carrying your health insurance (such as a spouse or parent) or a person covered by your plan dies, this is a qualifying life event. You can make changes to your plan outside of annual open enrollment.
You will often be required to provide a copy of a death certificate within 30 to 60 days of the loss. You may also need something that proves you were getting health coverage because of your relationship to the person who died.
What you need to provide
The specific information you need to provide will depend on the exact family change you’re experiencing. However, you will likely have to provide proof of prior coverage. One example is a letter from your insurance company or employer that lists the names of everyone on the health plan.
4. Your 26th birthday
When you turn 26, you can no longer be covered by a parent or guardian’s healthcare plan. However, this is a qualifying life event that will allow you to get your own health insurance. If your job offers health insurance that you haven't signed up for yet, contact your human resources department. Doing this before you turn 26 will help you find out what actions you need to take.
What you need to provide
You’ll be asked to provide proof of prior coverage within 60 days of your 26th birthday. This can be a letter or insurance card from your parent’s insurer that has your name listed as a dependent.
5. Change of residence
A change in zip code may qualify you for special enrollment if:
You move to an area where your current coverage isn’t available.
You move to or from a shelter or transitional housing.
You’re a seasonal worker moving to or from where you both live and work.
You’re a student moving to or from where you attend school.
You moved to the U.S. from another country.
What you need to provide
You’ll need proof of prior qualifying health coverage within the last 60 days. Depending on the scenario, you’ll also need to provide proof of the following:
Lease, rental agreement, or mortgage deed
Front and back of driver’s license or state identification card
U.S. Postal Service change of address confirmation
Official school enrollment and housing documentation
Letter from current or future employer stating you relocated for work
Green card, education certificate, or visa if you moved to the U.S. from another country
6. Job changes
Whether you were laid off, dismissed, retired, or quit, changing jobs qualifies you for a special enrollment.
During the special enrollment period, you have the opportunity to explore various health insurance options. You can choose a plan offered by your new employer. Or you can shop for a plan through the health insurance marketplace. Either way, you can choose the health insurance plan that best suits your needs and budget.
What you need to provide
As in other qualifying event scenarios, you’ll need to provide proof of insurance within the last 60 days. You could also be asked to provide any of the following:
Employee hire letter
Employment contract
Termination letter
Letter of resignation
Statement of insurance
Certificate of coverage
7. Other qualifying events
There are a few other, less common circumstances that may qualify you for special enrollment. Each has its own forms of documentation required, depending on the circumstance. These special qualifying life events include:
You’ve gained membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
You’ve recently become a U.S. citizen
You’re leaving incarceration (jail or prison)
You’re an AmeriCorps member starting or ending your service
How long do I have to enroll or switch plans if I experience a qualifying life event?
Typically, you have 60 days from the date of the qualifying life event to enroll in a new health insurance plan. However, it's important to act quickly during this time so you don’t experience any breaks in coverage, which can be risky.
In some cases (such as marriage, divorce, or a 26th birthday) you may be able to compare different plans ahead of time. This way, you can maximize the 30 to 60 day window in which you’re eligible to make changes.
The bottom line
Qualifying life events include marriage, having a baby, and aging out of a parent’s health insurance plan. If you experience a qualifying life event, you can change your health insurance plan outside the standard enrollment period. However, it’s important to review what documentation you will need to obtain another health insurance plan . Understanding the different qualifying life events and the actions required can help you avoid a lapse in coverage.
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References
HealthCare.gov. (n.d.). Enroll in or change 2023 plans — only with a Special Enrollment Period.
HealthCare.gov. (n.d.). Federal poverty level (FPL).
HealthCare.gov. (n.d.). Getting your own health coverage when you turn 26.
HealthCare.gov. (n.d.). Submit documents to confirm your loss of coverage.
Washington State Health Care Authority. (n.d.). What is special enrollment?
