Life Qualifying Measures for Special Enrollment

Each year, Americans are allowed a certain period of time to change or enroll in individual and family private health insurance coverage for the following year. This is known as the Open Enrollment Period (OEP), which typically runs from November to mid-January.

But what if you need to sign up for health insurance outside of that time frame? You have options. Let’s take a look at how a qualifying life event can make you eligible for the Special Enrollment Period and what life changes qualify.

What is a Special Enrollment Period (SEP)?

A Special Enrollment Period (SEP) is a window of time when people can enroll in health insurance outside of the Open Enrollment Period. It is usually triggered by a qualifying life event (QLE). A SEP ensures that people who undergo certain life changes, especially those that result in a loss of health coverage, can enroll in a new health plan.

What is a qualifying life event?

A qualifying life event, sometimes called a change in qualified status, is a change in your current situation that qualifies you for SEP. But what does that mean? Think of it in terms of a major life event. If you experience something that affects your family size or involves a change in residence, income, or your access to health insurance, you may be eligible.

How many days after a qualifying life event do you have to enroll in a health insurance plan?

In most situations, you have 60 days from the date of the qualifying life event to apply for health insurance. But this looks different from state to state. Depending on the situation, some states will allow you a 60-day window, both before and after a qualifying life event, to enroll in coverage.

Status changes. Marriage, Divorce and Legal Separation

Getting married, divorced, or legally separated are considered qualifying life events. In each situation, the size of your family changes and the coverage needs to be adjusted to reflect that change.

Marriage. For those who are getting married, you will be given 60 days from the date of your marriage to change your coverage, including adding a spouse to your employer-sponsored health plan.

Divorce or legal separation. In the event of a divorce, the spouse who does not carry the policy can purchase their individual plan through the SEP if they have a divorce decree or proof of legal separation. However, this can be complicated depending on legal processes and state regulations.

Is getting pregnant a qualifying life event?

Although it varies by state, in most cases getting pregnant is not considered a qualifying life event. But don’t worry. if your prenatal care is provided in-network, your current insurance should cover it. It’s important to call your insurer and ask questions before your first prenatal appointment to see what your insurance will and won’t cover.

What about giving birth or adoption?

Birth and adoption are both considered qualifying life events because you add a new dependency to your health insurance and change the size of your family. Typically, parents have 60 days after the birth or adoption of a child to sign up for insurance for their baby.

Is losing or getting a new job a quality life event?

Yes, if you lose your employer-sponsored health care, you are eligible for the Special Enrollment Period. There is no difference between leaving the workplace voluntarily, such as in the case of a layoff, or involuntarily, such as in the case of a layoff or layoff.

Voluntary or involuntary loss of health insurance coverage

In most cases, an involuntary loss of health insurance, such as through divorce or the death of a family insurance holder, qualifies you for a SEP. But what about the volunteer? And what is considered a “voluntary loss”?

You will not qualify for the Special Enrollment Period if you voluntarily drop your coverage. This includes losing your coverage because you haven’t paid your premiums or decided to drop out of a parent or guardian’s plan.

Is leaving a job an involuntary loss of health insurance?

Yes, leaving a job, regardless of the situation, is considered a voluntary loss of health insurance. This may come as a surprise if you’ve quit your job voluntarily, but think about it this way. Although you may choose to quit your job, you are not technically choosing to lose your health insurance.

Ending Medicaid coverage

You may be eligible for SEP if you are denied or lose Medicaid coverage because of a change in income, your family does not have an age-matched child covered by the Children’s Health Insurance Program (CHIP), or another qualifying circumstance occurs. You can contact your state’s Medicaid office to learn more.

Is a spouse leaving a job a qualifying event?

Yes! If your spouse quits, it’s considered a voluntary loss of health insurance regardless of the situation. If you had a job that provided health insurance, you would be able to look for a new plan during the Special Enrollment Period. If your spouse quits his job and you want to include him in your health insurance, that will also trigger a SEP.

Is turning 26 a qualifying life event?

Turning 26 is a life-qualifying event. This is when most dependents lose access to their parents’ health insurance. Depending on where you live, you may have 60 days before your coverage ends and 60 days after to find a new plan during the Special Enrollment period.

If there is a death in the family

If you share health coverage with a deceased family member, that’s a qualifying life event. Examples may include the loss of the primary owner of your family’s health insurance policy, the loss of a minor child, and the loss of a family member whose income contributed to the insurance coverage.

If you go out of coverage

If you drop out of your health plan’s coverage, you may be eligible to enroll in a new plan during the SEP. According to, this can include moving to a new zip code, leaving a transitional housing situation, such as a shelter, or transferring a student to school.

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