Normally, the chance to enroll or make changes to your health insurance comes around once a year during the open enrollment season. However, life has a way of shaking things up, and when certain significant changes occur—known as qualifying life events—you might end up qualifying for a special enrollment period. This means you could secure health coverage outside the typical enrollment times. Changes that might trigger this include alterations in your household setup, relocation, modifications to your health coverage, or other significant events.
What are the types of qualifying life events?
HealthCare.gov recognizes four main types of qualifying life events:
1. Household changes within the last 60 days, such as:
- Divorce or legal separation that leads to a loss of health coverage.
- Welcoming a new child through birth, adoption, or foster care placement.
- Losing a family member, if their passing results in a loss of coverage.
2. Residential changes, which might happen when:
- You move to a different ZIP code or county.
- You relocate for school.
- You move due to seasonal work.
- You transition into or out of a shelter or other temporary housing.
- You arrive in the U.S. from a U.S. territory or another country.
Note: For residential moves, it’s important to have had qualifying health coverage for at least a day in the 60 days prior to moving. Just going on vacation or moving for medical treatment doesn’t count.
3. Loss of health coverage
If someone in your household has recently lost qualifying health coverage, or anticipates losing it soon—maybe you’re turning 26 and can no longer be on a parent’s plan—you may qualify for special enrollment. This also includes losing coverage from an employer or other related sources.
Individual health coverage
For those with non-employer plans, you might qualify if:
- Your marketplace or individual plan is discontinued.
- You’re no longer eligible because you moved beyond the plan’s service area.
- You lose eligibility for a student health plan.
- A decrease in household income now qualifies you for marketplace plan savings.
- Your health plan ended mid-year without renewal.
Medicaid or CHIP
You could qualify if you lost Medicaid or CHIP in the last 90 days. This includes attempting to sign up during open enrollment and being denied, but open enrollment has already ended.
Medicare
You qualify if you’ve lost premium-free Medicare Part A, but not if you lost Part B or D, or lost Part A due to unpaid premiums.
Employer reimbursement
Special enrollment could be available if you or someone in your household was offered an HRA, ICHRA, or QSEHRA recently or expect to be within the next 60 days.
4. Other qualifying events
Additional situations might also be qualifying events, including:
- Income changes that impact eligibility.
- Becoming a member of a federally recognized tribe or gaining status as an ANCSA Corporation shareholder.
- Starting or ending service with AmeriCorps.
- Being released from incarceration.
- Being affected by a natural disaster or uncontrollable event like a flood or hurricane.
How can I sign up for coverage if I have a qualifying life event?
First, check your eligibility for special enrollment at HealthCare.gov. If you qualify, you can either set up a new marketplace account or update your existing one with the recent life change. Remember, if you’ve relocated to a new state, you’ll need a fresh application. You can manage your marketplace account around the clock, except for holidays, by calling HealthCare.gov or your state’s marketplace if applicable.
What documents might I need to sign up for coverage?
To verify your eligibility for a special enrollment period, you’ll need to provide documentation with your name and the date coverage was lost. This can be done by uploading files to your application or mailing them. It’s a good idea to select a new plan promptly and get the required documents sent within 30 days.
The type of documentation varies by event. Acceptable documents can include:
- A letter from your employer specifying changes or termination in health coverage on official letterhead.
- Correspondence from your insurer about coverage cancellations.
- Official health care program documents showing when coverage ended.
Additional documents might include pay stubs, legal documents for marital status changes, or death certificates, among others.
Note: If you can’t provide the necessary documents, a letter of explanation might be accepted.
How soon will my new health coverage begin after I sign up?
After your previous coverage ends, and once you’ve completed the enrollment process—including document submission and payment of your first premium—your new coverage generally starts on the first day of the following month.
