Special Enrollment: Qualifying Events for Health Insurance Coverage

Need to get health insurance but just found out that the Open Enrollment Period (OEP) is over? Open Enrollment typically lasts from November 1 until December 15 and is the one time of year that individuals who buy their own health insurance can get insured or switch plans with no strings attached. In order to enroll in a plan or switch to a different plan outside of OEP, you’ll need to have what’s called a “qualifying event.” Qualifying events for health insurance make you eligible for a Special Enrollment Period (SEP), during which time you can enroll in a new plan or switch plans.

Common Qualifying Events for Health Insurance Coverage

There are a handful of special circumstances and life events that can qualify you for SEP; these circumstances and events make up the most common qualifying events. While the qualifying events listed below vary in nature, most have one thing in common: you need to have had health insurance prior to the qualifying event in order to be eligible for SEP. There are a few instances where this is not the case and these are noted below.

Some of the most common qualifying events for health insurance coverage include:

  • You lose job-based coverage. This happens when you lose health insurance coverage through your company or spouse’s company. Be sure to note that you qualify for SEP when you lose job-based coverage even if you quit your job! However, losing coverage because you didn’t pay your premium does not qualify you for SEP.

  • You lose COBRA coverage.

  • You turn 26 and lose coverage through your parent’s plan. With the creation of the Affordable Care Act, people are allowed to stay on a parent’s health insurance plan until they turn 26. Under the ACA, 26 is when you become responsible for your own health insurance. Keep in mind, if you are not on a parent’s health insurance plan, turning 26 is not a qualifying event for you.

  • You lose your eligibility for Medicaid, CHIP, or Medicare.

  • You have a baby or adopt a child. Having a baby or adopting a child is considered a change in household and makes you eligible for SEP. If you already have coverage, you can add your dependent to your plan, or you can switch to a new plan as long as you add the child to it. If you didn’t have coverage before, you can’t enroll yourself in a plan, but you can enroll your dependent.

  • You get married or divorced. While you might be more focused on celebrating your marriage, getting insurance figured out with your new spouse should be one of your top priorities! If you don’t have coverage, you can join your spouse’s plan (and same goes for the reverse). In addition, if either of you want to make a change in coverage and find a new plan, this is the time to do it. Getting a divorce or legally separated also qualifies you for SEP. However, you are only eligible for SEP through a divorce if you lose existing coverage because of the divorce.

  • You have a death in the family. If you lose coverage because of a death in your family, you can enroll in health insurance outside of OEP. Additionally, if your dependents lost coverage due to the death, you can change your plan to cover them. Lastly, if you aren’t eligible for your plan any more because of the death of someone on the policy, you are eligible for SEP. 

  • You move to a new zip code or county. There are a few intricacies associated with moving in order for it to count as a qualifying event for you. First, the move must be permanent; it can’t just be for a vacation or to receive medical care. Second, if you move to a new state, you will always qualify for SEP because each state carries different health plans. However, a move within a state can also qualify you for SEP because some plans are only offered in specific regions of a state. If you move to a new region within the same state, the new region must either have plans that weren’t available in your previous region or not have your previous plan in order to qualify you for SEP.

  • Your income changes significantly, making you newly eligible (or ineligible) for subsidies.

  • You gain US citizenship. This is one of the qualifying events for health insurance in which you don’t need to have had previous coverage in order to be eligible for SEP. If you gain US citizenship, become a US national, or become lawfully present in the US, you are eligible for SEP because you are considered newly eligible to purchase coverage from the exchanges.

  • You are or gain status as an American Indian or Alaska Native. This is another one of the qualifying events for health insurance in which you don’t need to have had previous coverage in order to be eligible for SEP. You can enroll in a plan or switch plans at any point during the year. More on this here.

  • You leave incarceration. This is yet another one of the qualifying events in which you don’t need to have had previous coverage in order to be eligible for SEP.

The Fine Print

There are a few things you should keep in mind when it comes to qualifying events for health health insurance.

  • You are operating within a fixed timeframe. You have 60 days before the qualifying event and 60 days after the qualifying event to get enrolled. If you don’t do it within this timeframe, you will need to wait until the next OEP to enroll in a plan.

  • If you have a baby or adopt a child, your coverage can be back-dated. Coverage for dependents is retroactive to the day of the event meaning that it’s back-dated to the date in which you gave birth or the adoption went through.

  • You will be required to provide documentation supporting eligibility for the qualifying event you claim. The type of documentation will vary based on the qualifying event you are claiming. 

What’s Next?

If you’ve determined that you have experienced one of the qualifying events for health insurance (or will within the next 60 days), be sure to start shopping for your plan now. Stride is here to help you find the right plan at the best prices.

Unsure if you have a qualifying event? Stride has got you covered. Email us at support@stridehealth.com and we will help you get things figured out.

If you don’t have a qualifying event and can’t enroll in health insurance right now, you can still protect yourself and your family with dental, vision, and life coverage! Stride is here to help you save time and money on this so you can get back to doing what really matters to you. Check out Stride’s dental, vision, and life insurance options now.