What is a qualifying life event and how does it affect health insurance enrollment?

Outside of the annual Open Enrollment Period (typically November 1 – January 15), you can only enroll in or change a marketplace health plan if you have a qualifying life event. A QLE triggers a Special Enrollment Period (SEP) that usually lasts 60 days from the date of the event. The HealthCare.gov SEP overview lists all recognized qualifying events.

Common qualifying life events

• Losing health coverage: job-based coverage ends, COBRA runs out, or aging off a parent's plan at 26.
• Changes in household: marriage, divorce, birth, adoption, or death of a family member.
• Changes in residence: moving to a new state or ZIP code, graduating and moving away from home.
• Changes in income or household size that affect your subsidy eligibility.
• Gaining citizenship, being released from incarceration, or leaving a health care sharing ministry.

How to use a Special Enrollment Period

When a QLE occurs, you generally have 60 days to enroll in a new plan. Log in to HealthCare.gov or your state's exchange, report the life event, and select a new plan. Coverage typically starts the first of the month after you enroll. Documentation may be required — for example, a termination letter from your prior insurer when losing job-based coverage.

Medicaid and CHIP: no SEP required

Medicaid and CHIP (Children's Health Insurance Program) enrollment is open year-round — there is no enrollment window and no qualifying event requirement. If your income drops and you may now qualify for Medicaid, apply any time at your state Medicaid agency or via HealthCare.gov.