What is considered a qualifying event to change health insurance?

Key Takeaways

A qualifying event is a major life event that qualifies you for an Special Enrollment Period, allowing you to make changes to your existing health insurance plan outside of open enrollment
Many major life events are considered qualifying events, including the birth of a child, a recent move, or a change in your marital status.
There are a few strict enrollment deadlines to consider when making changes to an Affordable Care Act-compliant health insurance plan as a result of a qualifying event.
If you experience a qualifying event, Health Insurance Providers can help you compare plans in your area in order to help you find better coverage for you and your loved ones.

What is a qualifying event?

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Usually, an individual or a family can only purchase a health insurance plan during the Open Enrollment Period. Any life event that triggers a Special Enrollment Period (SEP) during which you are freely able to enroll in a new health insurance plan is considered a qualifying event.

There are several important questions to keep in mind when talking about qualifying events. For example, what life events are considered to be worthy of an SEP? What types of health insurance plans have qualifying events? How long does one have to select a plan following a qualifying event? You can get answers to all these questions and more right here at Health Insurance Providers.

What are some examples of qualifying events?

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On both the individual and family health insurance market, including on-exchange and off-exchange coverage, there are many examples of major life events that may be considered a qualifying event, allowing you to freely make changes to your coverage.

The following major life events are usually considered qualifying events by most insurance providers under the Affordable Care Act (ACA):

The birth or adoption of a child.
A change in marital status, including getting married or getting divorced.
A loss of other health insurance coverage.
A permanent move to a new area.
A change in income that affects your subsidy eligibility or moves you out of Medicaid eligibility.
Becoming a U.S. citizen or lawfully present resident.

What types of health insurance plans have qualifying events?

Qualifying events are used to trigger SEPs across all ACA-compliant major medical plans, including those on the individual market, small group, and large group insurance plans. All of these plans allow you or your family member to enroll in coverage or make changes to your existing coverage due to a qualifying event.

Qualifying events also apply to plans that are considered to be semi-compliant with the ACA, including grandfathered or grandmothered plans. Certain qualifying events will also trigger SEPs for Medicare coverage.

Other types of health insurance policies, such as short-term medical plans, are not required to honor qualifying events and are not required to grant SEPs as a result of them.

How much time do I have to take advantage of an SEP after experiencing a qualifying event?

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When you experience a qualifying event, you have 60 days to select a plan from the individual or family ACA insurance market or switch to a new plan. Depending on the qualifying event you have experienced, you may also be eligible to receive an SEP window that begins 60 days before the qualifying event and 60 days after the qualifying event occurs.

In most cases, your coverage will be effective on the first day of the following month, provided you enroll by the 15th day of the previous month, though this deadline will no longer be imposed beginning in 2022.

Keep in mind that there may be different effective dates for specific qualifying events, including marriage, birth or adoption of a child, and loss of other coverage. For Medicare, most qualifying events trigger a 2-month SEP, with a few exceptions.

If you experience a qualifying event and need to make changes to your health insurance coverage with an SEP, Health Insurance Providers can help you compare plans in your area in order to help you find better coverage for you and your loved ones. Enter your zip code in our free search box below to start comparing plans and prices today!