Qualifying Life Events for Health Insurance: How to Enroll Outside of the Open Enrollment Period

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 is a qualifying life event (QLE)?

A qualifying life event (QLE) occurs when there is a significant change in your life circumstances, such as a marriage, new child, or job loss. It opens up a special eligibility period (SEP) during which you can make changes to your health plan. You can sign up for new or additional coverage, or add or remove a qualifying family member on 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 or your family with inadequate coverage. It’s important to know what qualifying life events are and the actions and paperwork required to update your coverage. 

List of qualifying life events for health insurance

Qualifying life events allow you a unique chance to adjust your health insurance plan to keep up with life changes. Here are some common QLEs and what you should know about each one: 

1. Loss of health coverage

If you or someone in your household loses healthcare coverage, you may be eligible for a new plan if your coverage was provided by any of the following: 

• Employer

• Student plan

• Parents

• Own individual plan

Documents required for loss of health coverage

To apply for health insurance after losing coverage, you may need to show proof that your coverage ended or will end within 60 days. This can include any of the following: 

• Letter from your previous insurance company

• Letter from an employer

• Documentation from your COBRA administrator 

All documentation must include the date coverage ended or will end.

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• Need affordable healthcare? You may have access to free or low-cost services nearby.

2. Loss of eligibility for Medicare, Medicaid, or CHIP

Changes in income or family status can cause you to lose eligibility for government programs, such as Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). If this happens, you may qualify for new coverage. 

Eligibility for Medicaid or CHIP is typically determined in relation to the federal poverty level (FPL), which varies by state. For example, during 2025, a family of four with children under age 19 would need an income below $32,150 to qualify for these programs. If either of those things changes — for instance, if a child turns 20 or the family’s income goes up — they may lose eligibility. 

Most people get Medicare Part A at no cost, but some people may not be eligible for free coverage. You might qualify for a special enrollment period if you lose your premium-free Part A coverage — for example, if you were under age 65 and received Medicare due to a disability, but your condition improved. However, you won’t qualify for special enrollment if you lose Part A because you didn’t pay your premium, or if you only lose coverage for Part B or Part D.

Documents required for loss of healthcare eligibility

You may need a letter from your state’s Medicaid office or Medicare confirming loss of coverage, and possibly proof of income. 

3. Changes to your family

Certain changes to your family may qualify you for a special enrollment period. These are some of the most common family-related qualifying life events:

• Getting married

• Having a baby

• Adopting a child

• Gaining a foster child

• Gaining legal guardianship of a child

• Getting divorced or legally separated

• Losing a loved one, such as a spouse or parent who provided your coverage

If one of these events happens, you can change your plan or enroll in a new one. You typically have 30 to 60 days to report changes and submit documents.

Documents required for family changes

Here are some examples of required documents for different qualifying events:

• Marriage: Copy of your marriage license

• Birth or adoption: Birth certificate, hospital birth record, adoption decree, or placement letter

• Foster care or guardianship: Legal guardianship document or court order

• Divorce or legal separation: Divorce, separation, or annulment papers that include the end date of healthcare responsibility

• Death of a loved one: Death certificate, plus proof that you were previously covered under their plan (such as a benefits letter or insurance policy)

• Proof of prior health coverage: Letter from your insurer or employer with the names of covered individuals and the plan’s end date

Providing the correct documentation helps ensure a smooth transition. It also avoids any delays in getting or updating your coverage.

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.

Documents required for your 26th birthday

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 parents’ insurer, with 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 live and work.

• You’re a student moving to or from where you attend school.

• You moved to the U.S. from another country.

Documents required for a change of residence

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 your current or future employer stating that you relocated for work 

• Green card, education certificate, or visa if you moved to the U.S. from another country

6. Employment changes

Whether you were laid off, dismissed, retired, or quit, changing jobs qualifies you for a special enrollment. 

During the special enrollment period, you can 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.

Documents required for a change of employment

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 hiring letter 

• Employment contract

• Termination letter

• Letter of resignation

• Statement of insurance

• Certificate of coverage

7. Your 65th birthday

Turning 65 marks the start of your Initial Enrollment Period (IEP) for Medicare. This period lasts for 7 months; it begins 3 months before your 65th birthday, includes your birthday month, and ends 3 months after your birthday. 

If you don’t enroll during this window, you may qualify for a special enrollment period under certain circumstances — for instance, if you’re still working and covered by an employer plan. However, this extra window is limited. If you miss it, you’ll have to wait for the next Medicare General Enrollment Period (GEP) and may face a late enrollment penalty on your monthly premium.

Documents required after your 65th birthday

To enroll in Medicare after turning 65, you’ll need to provide a few key documents. These may include:

• Birth certificate or another document proving your date of birth

• Proof of U.S. citizenship or legal residency if you were born outside the U.S.

• Social Security card, especially if you’re already receiving benefits

• Details about your current health insurance, including coverage type and start dates

• Employment verification, such as a recent W-2 form (if you’re still working)

• Military discharge papers if you served before 1968

Other qualifying events

There are a few other, less common circumstances that may qualify you for special enrollment. Each has its own documentation requirements, depending on the circumstances. 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 or national.

• You're lawfully authorized to reside in the U.S.

• You’re leaving incarceration (jail or prison).

• You’re an AmeriCorps member starting or ending your service.

• An error occurred with your enrollment or you were enrolled in an incorrect plan.

• You or a dependent are eligible for a premium tax credit.

• You experience spousal abandonment or are a survivor of domestic abuse.

• You submitted the required document, but your eligibility was not confirmed before your previous coverage ended.

• Your employer now offers an individual coverage health reimbursement arrangement (HRA) or a Qualified Small Employer HRA (QSEHRA) as part of its benefits.

• You can show proof that your health plan violated a key component of the contract.

You may also qualify for a special enrollment period if something unexpected happens that prevents you from signing up for health insurance on time. This could include a serious health issue, natural disaster, or national or state emergency.

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 period 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 plans ahead of time. This way, you can maximize the 30- to 60-day window in which you’re eligible to make changes.

What if I do not qualify for a special enrollment period?

Not all life changes will qualify you for a special enrollment period. Events such as choosing not to enroll in your job's health plan, letting travel or short-term insurance expire, or voluntarily canceling your current plan typically do not meet the requirements for an SEP. Other nonqualifying situations may include:

• Gaining guardianship of a dependent without a court order

• Losing coverage due to not providing required documentation

• Leaving a medical cost-sharing group

If you're between enrollment periods and haven’t had a qualifying life event, here’s how you can bridge the gap and stay covered:

• Apply for Medicaid or CHIP: Enrollment is open year-round and based on income and household size.

• Look into short-term health insurance: It provides temporary coverage for unexpected situations.

• Plan ahead for the next open enrollment period: Marketplace plans are usually available from November 1 to January 15. Check with your employer or private insurer for private plans.

• Visit community health clinics: They offer affordable or sliding-scale health services.

• Check your eligibility for COBRA: This program allows you to continue job-based coverage if you recently became unemployed.

These options can help you avoid being uninsured. And if you believe you should have qualified for SEP but were denied, you may be able to file an appeal to have your case reviewed.

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Written by:

DeShena Woodard, BSN, RN

DeShena Woodard, BSN, RN, is a Texas-based registered nurse, freelance writer, financial freedom coach, and certified life coach. Writing about personal finance for more than 3 years, her advice has been featured on Yahoo Finance, Business Insider, NerdWallet, Debt.com, GoBankingRates, the Balance, and also on her own website, ExtravagantlyBroke.com.

Edited by:

Charlene Rhinehart, CPA

Charlene Rhinehart, CPA, is a personal finance editor at GoodRx. She has been a certified public accountant for over a decade.

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