What Is a Qualifying Life Event?

Qualifying Life Events Explained

Definition

A qualifying life event is when you experience a change in your life or financial situation in which you lose or need to change your health insurance coverage. As a result of a qualifying life event, you're eligible for a Special Enrollment Period, allowing you to apply for health insurance outside the annual Open Enrollment Period.

how a qualifying life event works
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The Balance / Julie Bang

Key Takeaways

  • Qualifying life events are changes that make you eligible for a special enrollment period for health insurance.
  • Examples of qualifying life events include a change in your job, location, income, or family status, such as a marriage or divorce.
  • You can make changes to your health plan, like adding or deleting a spouse or dependent, when you have a qualifying life event. 
  • Health plans will often allow you to make changes to your coverage for 60 days after this type of event. 
  • You can look into Medicaid, CHIP, a member health plan, or short-term health insurance if you don't meet the rules for a special enrollment period.

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, divorced, or having a child. You have a special time during which you can make changes to your health plan after one of these events.

Note

Contact your company as soon as you can to start this special process.

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.

Note

The Open Enrollment dates for the Health Insurance Marketplace to watch out for are:

  • Open Enrollment begins on November 1
  • Enroll by December 15 for coverage to begin on January 1
  • Open Enrollment ends on January 15

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.

Note

These cases are referred to as "complex issues." They're reviewed on a case-by-case basis.

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)

What does qualifying life event mean?

A qualifying life event is when you experience a change in your life or financial situation that makes you eligible for a Special Enrollment Period, allowing you to apply for health insurance outside the annual Open Enrollment Period.

What is considered a qualifying life event?

Qualifying life events can include a change in your family, such as a marriage or divorce. Also, having a baby or adopting a child and a death in the family are usually qualifying life events. Loss of your job, health insurance, or a change in where you live may qualify too.

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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. HealthCare.gov. "Qualifying Life Event (QLE)."

  2. HealthCare.gov. "When Can I Enroll in 2023 Marketplace Insurance?"

  3. Healthcare.gov. "Enroll in or Change 2021 Plans—Only With a Special Enrollment Period."

  4. Healthcare.gov. "Special Enrollment Periods for Complex Issues."

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