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Everything you need to know about qualifying life events

Life is... unexpected. And sometimes, we have to make sudden changes or pivots to our situation. While that’s sure to make the planner-types shudder at the thought, luckily, the world of health insurance has a few rules in place to make those changes a bit easier to lean into.


So if you thought you could only change your health insurance during the annual Open Enrollment Period, think again. (Well, only if you’re experiencing a qualifying life event.) Keep reading to find out more about this not-so-secret loophole below.



What is a qualifying life event?

A qualifying life event (or QLE) is a change in your situation (like getting married, having a baby, or losing health coverage) that can make you eligible for a 60-day Special Enrollment Period outside the annual Open Enrollment Period.


What are examples of qualifying life events?


Family changes

Experiencing a change in your family life could mean your benefits need to change, too. Some changes that count as a qualifying life event include:


  • Getting married

  • Having a baby or adopting a baby

  • Divorce

  • Death of a member enrolled in your health plan


Turning 26

In the eyes of your health insurance company, turning 26 is a milestone birthday — it’s when dependents can no longer stay on their parents’ healthcare plan and must find insurance on their own. (Either through an employer or a Health Insurance Marketplace.)


Change of address

Many people might not know that moving is a qualifying life event — it could be that you relocate to an area where your current coverage isn’t available or with new health plans to consider. But even if it’s available in your new location, this is a chance to change it up!


Change in employment status

No matter if your change in employment status is due to a layoff, dismissal, resignation, or retirement, it’s considered a qualifying life event — and you have options. COBRA, or the Consolidated Omnibus Budget Reconciliation Act, may be one of them. This gives employees and their families who lose health benefits the right to choose to continue their group (or employer) health benefits for an extended (but limited) period of time.


Other qualifying life events

  • Earning U.S. citizenship

  • A change in income that changes your subsidy (benefits from the government to help offset the cost of health insurance) eligibility

  • Losing eligibility for Medicaid or Children’s Health Insurance Program (CHIP)



How long do you have to select a new plan or switch plans if you experience a qualifying life event?


If you experience a qualifying life event, you typically have 60 days to choose a new plan or switch to a different plan — but this can vary. This Special Enrollment Period is an exception to help you make the necessary changes to your health coverage. Without Special Enrollment Periods, you would usually have to wait until the next Open Enrollment Period to enroll in coverage.



How will your health insurance provider know you experience a qualifying life event?


We’ll cut to the chase: they won’t. (No matter how much you update your social media.) It is your responsibility to let your health insurance provider know and begin the process of switching your insurance if you need to.


If you know that a qualifying life event is in your future (for example, you’re getting married next month or just found out you’re expecting a baby), be sure to give the number on your health insurance member ID card a call. They’ll be able to help you determine what your options are — and how long you have until you need to make a decision.


And here’s a quick tip: while you’re on the phone discussing your options, make sure to confirm if your insurance will need to see any official documentation or paperwork. (Like a marriage license or mortgage.) Knowing what you need to switch ahead of time will make the transition that much easier.



What if you need a health insurance plan now, but haven’t experienced a qualifying life event?


If a life change happens that doesn’t meet the criteria to be considered a qualifying life event, you have another option to consider. Short-term health insurance plans can help you fill a gap in coverage for as little as one month to just under one year (which can hold you over until the next annual Open Enrollment Period).


Short-term health insurance might be a good idea if you:

  • Don’t qualify for a Special Enrollment Period and missed the Open Enrollment Period.

  • Are waiting for your Affordable Care Act coverage to start.

  • Want coverage for a few months until you can qualify for Medicare.

  • Just turned 26 and are coming off your parents’ insurance.

  • Are between jobs or waiting for benefits to begin at your new job.

  • Are healthy and under 65.


Short-term health insurance, also known as gap insurance or temporary insurance, is exactly that: for the short term, which can fill that gap in coverage until you choose a more long-term solution.


It’s important that your health insurance plan continues to meet your needs as life unfolds — it could save you more money and give you access to the best caregivers in your new area. So the next time you experience a qualifying life event, make sure to give your health insurance provider a call to find out what your options are. But don’t wait: your 60-day countdown starts immediately! (No pressure.)

Tags: Health, Health Insurance, Care

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