Your Guide to Understanding Qualifying Life Events and Special Enrollment Periods - NerdWallet

Your Guide to Understanding Qualifying Life Events and Special Enrollment Periods

Your Guide to Understanding Qualifying Life Events and Special Enrollment Periods

The open enrollment period for health insurance on the Affordable Care Act’s marketplaces and state exchanges only lasts for a few months each year. But don’t panic if this deadline came and went and you don’t have coverage.

You can still take action to avoid the penalty that comes with not being covered, and, just as important, to gain access to health insurance. Applying for a special enrollment period because you experienced a “qualifying life event” is one course of action.

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What are qualifying life events?

A qualifying life event occurs when a specific circumstance has altered your life — and there are strict guidelines determining exactly what those life events are.  

For example, if you were recently married, divorced or had a child, you are eligible to enroll in health coverage during a special enrollment period lasting 60 days. Involuntarily losing previously held health insurance also qualifies as a qualifying life event, as does changing your permanent place of residence. If your income has increased such that you are no longer eligible for Medicaid, you’ll also be able to enroll in new coverage through a special enrollment period. Starting or ending service with AmeriCorps is also considered a qualifying life event, and members of federally recognized Indian tribes can change exchange plans once per month throughout the year. Since the list of qualifying life events is so varied, it’s worth investigating whether a major change in your life makes you eligible for a special enrollment period.

A complete list of qualifying life events can be found here. To begin your application for a special enrollment period, go here.

Special enrollment periods

Unless specifically stated otherwise, the special enrollment periods for Affordable Care Act plans last 60 days from the date of the qualifying event, leaving you about two months to gain access to health coverage.

During that time, you can either enroll in a plan through the marketplace or outside of it if you are eligible for a special enrollment period but your income is too high to receive premium assistance.

The cost of your health insurance will depend on the type of plan you select, your age, your location and your income. If you select a plan during the first half of the month (1st-15th), your coverage will kick in on the first day of the following month. If you pick a plan during the second half of the month (16th-31st), you’ll be insured starting the first day of the second month. A newborn will be eligible on the date of his or her birth.

Once your new insurance kicks in, be sure to take advantage of free preventive benefits, in addition to any other care you need.

What if I don’t have a qualifying life event?

Don’t fret if you missed the open enrollment deadline and you haven’t experienced a qualifying life event. There are still a few ways to get health insurance. If your application for a special enrollment period was denied, you can appeal this decision. If you are eligible for Medicaid, you can apply for coverage at any point outside of open enrollment.

If those options don’t work for you, you can purchase a short-term health insurance plan, although you may have to pay the penalty for going uninsured if you lack coverage for more than three months. Keep in mind that certain hardships may also make you exempt from paying the penalty (e.g., the loss of a loved one or recently filing for bankruptcy).

Thanks to qualifying life events and special enrollment periods, you’re not limited to open enrollment on the Affordable Care Act’s marketplaces. Investing in health insurance now may save you thousands of dollars down the road.


Couple at laptop computer image via Shutterstock.
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