A qualifying event is an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual open enrollment period. Our guide to special enrollment periods goes into detail about each of the qualifying events.
In the individual market (on or off-exchange), qualifying events include:
- the birth or adoption of a child
- marriage (and divorce, if the exchange or insurer counts it as a qualifying event)
- loss of other coverage (as long as the coverage you’re losing is considered minimum essential coverage)
- a permanent move to an area where different health plans are available (as long as you already had coverage prior to the move)
- a change in income that changes your subsidy eligibility (only applies if you already have coverage through the exchange)
- an increase in income that moves you out of the Medicaid coverage gap
- a grandfathered or grandmothered plan’s non-calendar-year renewal
- becoming a US citizen or lawfully present resident
If you experience a qualifying event, you have 60 days to select a plan or switch to a different plan (in some cases, the ability to switch from one plan to another is limited during special enrollment periods). In most cases, the coverage will be effective the first of the following month if you enroll by the 15th of the month. But there are different effective date rules for marriage, birth or adoption of a child, and loss of other coverage.