What Is a Qualifying Life Event?

Can you buy individual health insurance at any time, or do you have to wait for Open Enrollment at the end of the calendar year?

In many ways, the answer is a little bit “yes and no.” But consumers in the market for an individual health plan do have more options than you might think!

One important to thing to understand? There are certain circumstances that allow you to qualify for a special enrollment window, allowing you to shop for qualified, Affordable Care Act-compliant plans outside of the Open Enrollment Period for your state.

What Is a Qualifying Life Event?

In order to qualify for a marketplace plan outside of the Open Enrollment Period, you must experience a change in situation that affects your health coverage.

If you experience one of these situations, known as qualifying life events (QLE), you may be eligible for a Special Enrollment Period, or SEP. An SEP generally offers you a 60-day window to enroll in a new plan.

So, what experiences count as qualifying life events? Generally, these events fall into one of four categories:

Family or Household Changes

Changes to your family that affect your health insurance coverage generally count as qualifying life events. Some examples include:

  • Getting married
  • Getting divorced or legally separated
  • Having a baby or adopting a child
  • Death of a family member

Employment Changes

If you belong to a group health plan, you may be eligible for a qualifying life event if you:

  • Lose your job-based health coverage
  • Experience a change in income that results in your losing eligibility for Medicaid or CHIP

Changes In Residence

A substantial move can often count as a qualifying life event, if you:

  • Move to a new state, zip code, or county
  • Relocate for a seasonal job or to attend school
  • Move into or out of the US

Loss of Coverage

Broadly speaking, you may also qualify for a Special Enrollment Period if you lose your existing health coverage. This could be due to any number of causes:

  • Turning 26 and no longer being eligible to stay on a parent or guardian’s plan
  • Your current individual plan is discontinued
  • Losing coverage based on your job, or status as a student

We should note that the examples we’ve listed above are only some of the situations that may count as qualifying life events. There are other, less common circumstances that may qualify you for Special Enrollment. At the same time, bear in mind that it is possible to be turned down for a Special Enrollment Period, even if you believe you qualify.

Are There Other Ways to Get Insurance Outside of Open Enrollment?

If you don’t want to or can’t wait for Open Enrollment, there may be other options out there that could work for you.

For example, you don’t have to wait for an Open Enrollment window for government coverage, such as Medicaid or Medicare. With Medicaid, coverage can start right away, at any time of the year (provided that you qualify). For Medicare, the period before and after your 65th birthday counts as your Initial Enrollment Period; you’ll also qualify for a special Medigap Open Enrollment Period during a certain time window, in which you can purchase private supplemental coverage.

If you’re a small business owner, it may be easier to enroll yourself and your employees in a group health plan than you may think. Most businesses with two or more employees will qualify, and you can start the process of setting up a group health plan at any time of the year.

Finally, it’s extremely important to remember that there are private, individual health plans available for purchase outside of the state exchanges. Many of these plans do not meet all of the requirements for minimum essential coverage under the Affordable Care Act (ACA), but many do offer unique benefits, such as broader provider networks, that you may or may not also find with a marketplace plan.

It’s very important to comparison shop between plans to ensure that you’re getting the coverage you need, at a price that works within your budget. It can be daunting attempting to buy a plan directly from an insurance provider on your own; you may wish to consult with an independent health insurance broker in order to ensure that you’re making the right choice for your needs.

Finding the Right Coverage for You

When it comes to health insurance, there are so many options out there that it can feel overwhelming just to get started.

To make matters even harder, health insurance laws and regulations always seem to be changing. If you don’t eat, sleep, and breathe insurance, navigating your coverage options can be complicated — and it’s only getting more dense and confusing by the day.

It’s easy to feel lost when it comes to finding the best coverage for your health insurance needs, especially when you find yourself trying to get a straight answer out of an insurance company, or struggling to understand all of your options on a clunky government site.

That’s where the Enrollment Specialists come in!

Led by our own health insurance superhero Matt Peebles, the Enrollment Specialists are here to help you find the right health and life insurance option for you!

During Open Enrollment, or at any time of the year, Matt is here to be your source for all things health and life insurance, including:

We don’t believe in cookie-cutter care, and we’ll work closely with you so that we can customize the best possible plan for your needs. We really get to know you, your family, or your business, making sure that your costs are minimized, while your coverage as always at its peak.

And this personal service doesn’t cost you anything. When you work with the Enrollment Specialists, we don’t charge you anything for a quote, to talk through your options with you, or even sign you up for a policy. Have questions? Call us!

Even better? With Matt on your team, you’ll always be able to say “I Got A Guy!” for all things health insurance. Whenever you have questions for the entire life of your policy, Matt is always just a quick phone call or email away. That’s right — you’ll always be able to get a hold of a real person who you know and trust, not a call center or faceless online chatbot.

Ready to get started? Don’t hesitate to drop us a line today to talk all things health and life insurance!

(Visited 40 times, 1 visits today)