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Those of us with life changes – or “Qualifying Life Events” (QLEs)– can skip the line when it comes to joining a health insurance plan. QLEs automatically grant you a 60-day Special Enrollment Period to enroll in health insurance during any time of the year.
Your Qualifying Life Event immediately begins a Special Enrollment Period (SEP) once it occurs. When you enter that Special Enrollment Period, you or your family can pick a new comprehensive health plan without penalty. You can also change your existing healthcare coverage.
Qualifying Life Events include the following:
Health Insurance QLEs include:
- You get married;
- You get divorced;
- You have a baby or adopt a child;
- The death of an individual living in your home reduces your reported household size;
- You experience a change in household size that impacts what you report to the government for your household tax subsidy;
- You have a change in income (either an increase or decrease) and need to report it to adjust your tax subsidy;
- You have an increase in income and no longer qualify for Medicaid;
- You lose your employer health insurance coverage;
- Your health insurance plan cancels your coverage, even though you’ve paid your premiums;
- Your COBRA coverage expires;
- You turn 26 years old and can no longer stay on your parent’s healthcare plan;
- You move to a different ZIP code;
- You are released from jail;
- You experience domestic abuse;
- You are discharged from the Armed Forces; and
- When applying for health insurance, an error is made – either human or technical error – which results in you not obtaining coverage.
Any one of these Qualifying Life Events opens the door to health insurance coverage adjustments if you choose.
If you’re looking for health insurance on HealthCareInsider.com outside of open enrollment, you’ll be asked which QLE you have. Without a Special Enrollment Period, your health insurance options will be limited.
In an ideal world, you’d sign up for health insurance within the winter open enrollment window, generally November 1 through January 15 each year. Health insurance companies aren’t allowed to enroll you outside of the open enrollment window without one of these good reasons. Fortunately, there are many ways to get a Qualifying Life Event.
You Have 60 Days to Use Your Special Enrollment Period (SEP)
Your Special Enrollment Period generally lasts for 60 days, starting from the day of your QLE.
Your policy will generally be effective on the first day of the month following your application, regardless of what date you complete your application.
Countdown Begins on the Day
Your Special Enrollment Period is a 60-day health insurance enrollment window. It begins on the day your qualifying life event takes place.
This means that if you get married on May 31, you must enroll in a new health insurance plan before the end of July. If you quit your job to form your own business, you have 60 days from the last day of employment to get new healthcare coverage. Once the 60-day window has passed, you have to wait until the regular Open Enrollment Period to obtain health insurance coverage or update your current coverage.
Some SEPs Are Truly Special
Additional QLE protections may apply, depending on your QLE circumstances. For example, if you have a baby, adoption, or foster care relationship, you can enroll in an ACA health plan for up to 60 days after the event and coverage can start the day of the event. Check the list above for more details.
If You Don’t Use Your Special Enrollment Period
You don’t have to change your health insurance if you don’t want to. If you lost your plan, however, you may be able to sign up for temporary health insurance. If you were incapacitated for part of the 60 days, you may be able to claim an additional SEP with the help of a health insurance agent.
Affordable Care Act administrators have specified that a lack of knowledge about COBRA is not a qualifying life event. In general, you cannot claim a Special Enrollment Period solely because you were not aware of your SEP. It’s still possible to get health insurance after open enrollment, even without a qualifying life event.
No Penalties for Using a Special Enrollment Period
If you use Special Enrollment, you will not pay additional monthly premiums. Affordable Care Act insurance plans must accept your application, just as if you were applying during open enrollment.
Everyone’s Special Enrollment Period Is Unique
Since the Special Enrollment Period is not a specific time period, your special enrollment will be different than someone else’s. Although you can figure out your own SEP, it’s not a recurring event.
Special Enrollment for Unrelated Products
Taxes and other healthcare items may promote their special enrollment periods. These are not the same as Special Enrollment Periods for Affordable Care Act plans.
Don’t Wait to Change Coverage
Changes in life happen every day. Many times when these life events occur, your health insurance plan is the last thought on your mind. However, not having enough insurance coverage can be physically and financially dangerous should an unexpected accident occur.
Without making a change in time, you could be without any coverage and won’t be able to add it when you need it. Make sure changing your health insurance policy does nothing but bring you peace of mind.
