Where can I find the list of Obamacare qualifying events?

Q. Where can I find the list of Obamacare qualifying events?

A. The majority of ACA-compliant plans are not available for purchase outside of the Obamacare open enrollment period unless you have a qualifying event that triggers your own special open enrollment window. This applies both on and off-exchange (except in Nevada, where off-exchange plans are available year-round, albeit with a waiting period).

Qualifying events and special enrollment periods didn’t apply in the individual market prior to 2014, as individual health insurance was subject to medical underwriting. But since 2014, enrollment outside of open enrollment has only been possible if you have a qualifying event. For the most part, qualifying events in the individual market are very similar to qualifying events that let people enroll in their employer’s plan outside of the employer’s open enrollment period. But there are some differents. Here’s the list of qualifying events for individual market plans:

  • Gaining or becoming a dependent as the result of birth, adoption or placement in foster care
  • Involuntary loss of coverage that was deemed minimum essential coverage (it still counts as involuntary if you opted to quit your job and therefore lost access to your employer-sponsored plan; losing access to your plan as a result of divorce also counts under this qualifying event)
  • Marriage
  • Moving to an area where different Qualified Health Plans (QHPs) are offered (as of July 11, 2016, this only applies if you already had minimum essential coverage in place for at least one of the 60 days prior to your move)
  • Gaining U.S. citizenship
  • Errors or problems with enrollment
  • Changes in your employer-sponsored health insurance to the point where your plan becomes unaffordable or no longer provides minimum value

If you’re already enrolled in a plan through the exchange, you’ll have a special enrollment period if your income changes such that you become newly-eligible or newly-ineligible for premium subsidies or cost-sharing subsidies.

For more expansive explanation of these qualifying events, read Qualifying events that can get you coverage.

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