What is a qualifying event?
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.
Read more about qualifying events and special enrollment periods in this article.
What types of health insurance use qualifying events?
Qualifying events trigger special enrollment periods in ACA-compliant major medical plans. These types of policies include individual market, small group and large group insurance plans – all of which have to enroll you or your family member into a policy due to a qualifying event.
Other types of policies (e.g., short-term medical plans) are not required to enroll you in coverage when you experience a qualifying event.
What are examples of qualifying events?
In the individual market (on or off-exchange), qualifying events include:
- 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 (may not apply off-exchange in states that run their own exchanges)
- 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
The qualifying events in the employer market are slightly different than these events listed above.
How long do I have to select a plan or switch to a different plan if I experience a qualifying event??
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.
The length of time to select a plan usually is only 30 days in the employer market.