What Is a Qualifying Life Event?

A qualifying life event determines when you can get new health care coverage beyond the open enrollment period. Qualifying life events can include childbirth, reaching an age where you are removed from your parents' insurance, marriage, or other major occurrences. It is a major change in your life circumstances that affects your health insurance needs.

Open enrollment for health insurance, under the Affordable Care Act, lasts a few weeks to a few months out of the year. Enrollment for 2018 is from November 1, 2017 to December 15, 2017. The previous year's enrollment went until January 31, 2017 and is variable based on the priorities of current administrations. It is possible to enroll outside of this period when there is a qualifying life event.

What Is an Open Enrollment Period?

The open enrollment period for the Affordable Care Act was previously three months long. Dates went from November 1st to January 31st. While legal changes to the Affordable Care Act have been minor, administrative changes have occurred limiting access to healthcare and reducing the time for open enrollment. The current window is now four weeks instead of twelve weeks, it spans from November 1st to December 15th. This may change in the future as priorities and motives change, so it’s important to check current administration guidelines.

What Is a Special Enrollment Period?

A special enrollment period, under the Affordable Care Act, is a period of time where you can enroll in or change your current healthcare plan. These special enrollment periods are triggered by a qualifying life event and usually last for sixty days. A special enrollment period can be any time of year and can happen outside of the open enrollment period. During this period of time, an individual may enroll in a healthcare plan through their state's Health Insurance Marketplace. This special enrollment period can vary depending on the type of qualifying event that has occurred.

Only those individuals who have experienced a qualifying life event will be eligible for the special enrollment period. Coverage that does not apply for special enrollment would include the loss of coverage not qualified as the minimum essential coverage.

How Soon Can You Get Coverage Started During A Special Enrollment Period?

Rules governing the open enrollment period of the Affordable Care Act also apply during special enrollment periods. A qualifying life event allows you to purchase coverage within your marketplace beginning on the first day of the following month if you have enrolled by the 15th of that month. There are, however, some exceptions that will allow coverage to begin on the same day. One example is the birth or adoption of a child.

What Is a Hardship Exemption?

Hardship exemptions also exist in exceptional circumstances. These can trigger a special enrollment period of 60 days. Some examples of an exceptional circumstance include natural disasters, an unexpected hospitalization, or even a temporary cognitive disability. An enrollment error that was created by HealthCare.gov, your insurance provider, or broker may also qualify as a hardship exemption.

How Will I Be Able to Get Health Insurance Plans if I Missed the Open Enrollment and I Don't Have a Qualifying Life Event?

Public programs exist if you have missed the period of open enrollment even if you aren't qualified for special enrollment. Children in low-income families may qualify for CHIP, which enrolls all year long without a limited enrollment period. You may also enroll in a temporary enrollment plan if you have missed the open enrollment period. Usually available directly from an insurance provider, they may be more expensive and not cover everything required under a plan received under the Affordable Care Act.

Other forms of gap health insurance coverage may be available to you. COBRA insurance is government regulated policies that allow you to maintain existing health insurance coverage you have lost due to loss of employment. While it is more expensive than coverage under the Affordable Care Act, it may offer more coverage since it is identical to the coverage you received through your employer and the private market.

What Are the Qualifying Events That Allow You to Register for Health Insurance Plans Outside of the Open Enrollment Period?

Many instances can trigger a special enrollment period and allow you to amend or obtain health coverage. One of the main instances is a loss of essential health coverage or a loss of current health insurance. Losing health coverage from an employer can qualify you for special enrollment on the healthcare market as governed by the Affordable Care Act. If you lose your job, your employer eliminates coverage, or you leave on your own, you and your dependents may qualify. This life event may include not only you but your spouse and dependents, as well.

A change of family structure may also be considered a qualifying life event. Gaining a dependent by birth, adoption, marriage, or a death in the family can qualify those persons for new health coverage.

Becoming a U.S. citizen can also qualify you for coverage. Additionally, becoming nationalized by gaining lawful employment can also qualify you.

If the government has made an error that has caused you to lose coverage, you may also be eligible to enroll for coverage outside of the open enrollment period of the Affordable Care Act.

A change in status that makes you newly eligible or ineligible for subsidies under the Affordable Care Act including tax credits or reductions in cost-sharing can make you eligible, as well.

Other changes that can trigger a special enrollment period include moving to a new area of coverage, being released from prison or jail, or returning from active military duty.

If you need help learning more about qualifying life events, you can post your legal need on UpCounsel’s marketplace. UpCounsel accepts only the top 5 percent of lawyers to its site. Lawyers on UpCounsel come from law schools such as Harvard Law and Yale Law and average 14 years of legal experience, including work with or on behalf of companies like Google, Stripe, and Twilio.