{“type”:“markdown”,“value”:"# Unlocking the Door to Health Coverage: Understanding Qualifying Events
A qualifying event is a significant life change that allows you to adjust your existing health insurance policy or sign up for a new one, outside of open enrollment periods. Without a qualifying event, you’re typically required to wait until the next open enrollment to make changes to your health insurance.
Key Points
- Life Change Opportunities: Qualifying events enable you to change your health insurance outside of predefined periods.
- Annual Enrollment Windows: Open enrollment typically happens at the end of the year with coverage beginning at the start of the next year.
- Common Events: Examples include the birth or adoption of a child, death of a spouse, or a change in marital status.
How Qualifying Events Work
In the United States, most healthcare services are covered by private health insurance plans, supplemented by government programs like Medicare and Medicaid. Many people obtain health insurance through their employers, which may cover some or all of the premiums, or purchase plans through the Health Insurance Marketplace.
Open enrollment periods usually take place at the end of the year. For instance, the Marketplace’s open enrollment runs from November through mid-December, with coverage starting on January 1. After this period closes, changes to your health insurance plan can only be made if you experience a qualifying event.
Qualifying life events—like marriage, divorce, having a baby, adopting a child, or the death of a spouse—allow for changes to your insurance policy under a special enrollment period. To benefit from this, you typically need to provide proof such as a birth certificate or marriage documentation. Most insurers require you to request changes within 60 days of the qualifying event.
Special Considerations
Employment-related changes, like losing or leaving your job, are uniquely handled through the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows you to temporarily stay on your employer\u2019s group health plan, often at a higher premium since you\u2019ll be covering the full cost. COBRA coverage typically lasts between 18 to 36 months, depending on circumstances.
Real-World Examples of Qualifying Events
The Affordable Care Act (ACA) has added new dimensions to what constitutes a qualifying event. For example, under the ACA, young adults can remain on their parent\u2019s health insurance until age 26. Their 26th birthday then becomes a qualifying event, allowing them to sign up for their own coverage.
Loss of existing health coverage, like losing a job or aging out of student health coverage, is also considered a qualifying event under ACA rules.
Important Enrollment Dates
Medicare
Open enrollment for Medicare runs from October 15 to December 7 annually. Coverage kicks in on January 1 of the next year and lasts through December 31.
Health Insurance Marketplace
Open enrollment through the Marketplace begins on November 1 each year. To ensure coverage starting January 1, you must enroll by December 15. For coverage starting February 1, you must enroll by January 15.
Can You Sign Up for Insurance After Open Enrollment?
If you missed the open enrollment period, options still exist based on your circumstances. Qualifying for Medicaid may make you eligible for special enrollment. Alternatively, you might consider short-term health insurance to bridge the gap until the next open enrollment.
The Bottom Line
Health insurance plans typically require adherence to open enrollment periods for making changes or signing up. Qualifying events, however, offer a vital lifeline, enabling policy adjustments or new plans whenever significant life changes occur. Key qualifying events include marriage, divorce, the birth or adoption of a child, and employment changes.
Related Terms: open enrollment, special enrollment period, health insurance marketplace, COBRA, Affordable Care Act.
References
- U.S. Centers for Medicare & Medicaid Services. “Dates and Deadlines”.
- U.S. Centers for Medicare & Medicaid Services. “Qualifying Life Event (QLE)”.
- U.S. Centers for Medicare & Medicaid Services. “Special Enrollment Period”.
- U.S. Department of Labor. “COBRA Continuation Coverage”.
- Centers for Medicare and Medicaid Services. “Medicare Open Enrollment”.
- Healthcare.gov. “A Quick Guide to the Health Insurance Marketplace”.
