What Is a Qualifying Life Event for Special Enrollment?
The gist
If you want to sign up for new health insurance or make changes to an existing plan, typically, the only time of the year when anyone can do so is during Open Enrollment Period (OEP).
If you miss your OEP, you may qualify for what’s known as a Special Enrollment Period (SEP). To be eligible for a SEP, you must first experience a qualifying life event.
Qualifying life events are major life events like getting married, divorced, having or adopting a child, moving, losing your job, and more.
If you have a qualifying life event, you typically have 60 days to enroll in new health insurance or make changes to your existing plan. Make sure you have documentation ready (like a birth or death certificate, marriage license, or other legal paperwork).
In this article
Did you miss your Open Enrollment Period? Did you just get married, and now you’re looking to add your spouse to your health insurance? Don’t stress — you may be eligible for what’s known as a Special Enrollment Period — but only if you’ve had what’s known as a qualifying life event.
Here’s our advice: Take a deep breath, center yourself, drink some water, and keep reading, because we’re about to tell you everything you need to know about Special Enrollment Periods and qualifying life events.
How do I become eligible for a Special Enrollment Period?
If you need to sign up for new health insurance or make changes to an existing plan outside of the OEP, you must first experience a qualifying life event. We’ll go over more specifics in the next section, but qualifying life events are major experiences — like a birth, a death, or a marriage in the household (to name a few) — that might necessitate changes to your health coverage.
Your SEP typically ends 60 days after your qualifying life event occurs (not 60 days from when you request the SEP), so you’ll want to make sure you have your documents ready as soon as you have them.
What is a qualifying life event?
Here are some of the most common qualifying life events:
Losing health care coverage:
Turning 26 and/or being removed from your parent’s insurance
Losing your employer-provided coverage due to job loss or weekly hour reduction
If a change in your income makes you ineligible for Medicaid, the Children’s Health Insurance Program (CHIP), or Medicare
Changes to the size of your household or family:
Getting married
Getting divorced
Having or adopting a child
Becoming a caretaker for a person who lives in your home and is elderly or disabled
A death in the family
Changes in your place of residence:
Moving to a new ZIP code or county
Moving to or returning from school
Other qualifying events include:
Leaving jail or prison
Becoming a U.S. citizen
Gaining membership or status in certain Native American or indigenous tribes that are recognized under the Alaska Native Claims Settlement Act
If you’re a rideshare or delivery driver in California, completing your first drive
If you’re a rideshare or delivery driver in California, driving an average of 15+ hours per week during a calendar quarter
Remember, you only have 60 days from when your qualifying life event occurs to sign up for new coverage or make changes to your existing health insurance. To prove your qualifying event, you’ll need to provide proper documentation (like a birth or death certificate, employment termination letter, or marriage license), so make sure you’re saving all your paperwork!
If you’re unsure if your life event qualifies, send your questions to our team here, and we’ll walk you through the details.
Is getting married a qualifying life event?
Yes! Getting married is a qualifying life event. Whether you’re looking to add your spouse to your health insurance or vice versa, getting married makes both of you eligible for a Special Eligibility Period that will allow you to make certain changes to your plan—as long as at least one of you had qualifying health insurance for at least one day during the 60 days before your wedding.
As we’ve mentioned above, you have 60 days to make these changes, so don’t delay! Which brings us to the task at hand: Once the honeymoon is over, it’s time to get down to business.
As soon as you get your marriage certificate or license, you can start shopping. You might be looking to add your spouse to your health insurance or they might be looking to modify their plan to cover you. You and your spouse might even take this SEP as an opportunity to shop for entirely new health insurance altogether! But remember — your 60-day SEP starts on the day you get married, not the day you applied.
