8 Life Events That Qualify for Health Insurance Special Enrollment

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  • Open enrollment for health insurance through the Marketplace runs November 1 through December 15 of each year. This is the time to shop for healthcare plans and see if you qualify for tax credits and other savings. Plans you buy during this time will take effect January 1. After the December 15 deadline, you can only make changes or buy a plan during a HealthCare.gov Special Enrollment. Special Enrollment for health insurance through the Marketplace can begin up to 60 before a qualifying life event. It runs until 60 days after the event. Here are the life changes that can make you eligible for Special Enrollment.

  • 1
    Changes in Household
    Woman with sonogram

    A change in your household is a qualifying event for health insurance. You may qualify if the following events occurred within the past 60 days to you or someone in your household:

    • Birth, adoption, or placement of a child in foster care. You have 60 days from the event to apply for coverage. Coverage will apply back to the day of the event.

    • Death. You can apply if you’re no longer eligible for coverage due to the death of someone on your Marketplace plan.

    • Divorce or legal separation. You qualify only if this legal action resulted in loss of your coverage.

    • Marriage. If you pick a plan by the last day of the month, coverage starts the first day of the next month.

  • 2
    Changes in Residence
    suburban homes

    A move may qualify you for Special Enrollment. In most cases, you’ll need proof of qualifying coverage for at least one day in the 60 days prior to your move. Moves that qualify include:

    • To a new zip code or county, as this can affect the plans available to you

    • To or from a place you attend school if you are a student or a place you live and work if you are a seasonal worker

    • To or from a shelter or transitional housing

    • To the United States from a foreign country or U.S. territory if you are a U.S. citizen or a lawful U.S. national. (No proof of prior coverage is necessary.)

  • 3
    Loss of Health Insurance
    Unseen Caucasian man carrying box of office items out of office building after quitting or being fired

    Losing health insurance can be a qualifying event if you, or someone in your household, lost coverage within the past 60 days or anticipate losing it in the next 60 days. This includes losing:

    • Coverage through a family member, such as a spouse’s or parent’s plan

    • Eligibility for Medicaid, CHIP (Children’s Health Insurance Plan), or Medicare Part A

    • Individual coverage you purchased yourself if you are no longer eligible, it was discontinued, or ended mid-year

    • Job-based coverage

    Note that voluntarily dropping coverage or losing coverage due to failure to pay premiums does not qualify for Special Enrollment.

  • 4
    Becoming Newly Eligible

    If you become newly eligible to apply for healthcare coverage through the Marketplace, you can use a Special Enrollment. This includes:

    • Becoming a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

    • Becoming a U.S. citizen 

    • Leaving incarceration

    • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

    For some of these categories, you become newly eligible for different levels of benefits through the Marketplace.

  • 5
    Exceptional Circumstances
    Wife consoling husband in hospital

    You may qualify if an exceptional circumstance kept you from applying during Open Enrollment. The two main categories are:

    • Natural disasters, such as an earthquake, hurricane, or devastating flooding

    • Serious medical conditions, such as unexpected hospitalization or other temporary incapacitation

    These are complicated cases that may require more extensive documentation. Should you receive a denial for Special Enrollment, there is an appeal process. This is true for the following life events as well.

  • 6
    Enrollment Errors
    frustrated father paying bills online

    There are three general types of errors that can prevent you from enrolling properly. Should these errors occur, you may qualify for Special Enrollment. Enrollment errors include:

    • Misconduct or inaction by an agent, broker, navigator, or someone else helping you enroll in an official capacity. Their behavior must have kept you from enrolling in a plan, enrolling in the right plan, or receiving eligible tax credits or cost savings.

    • Technical error on HealthCare.gov that kept you from enrolling or kept the insurance company from receiving your enrollment

    • Wrong data was given to you about the plan at the time of enrollment. This could include incorrect benefit or cost-sharing information.
  • 7
    Medicaid or CHIP Eligibility Issues
    woman pointing at financial record on table

    Medicaid and CHIP eligibility can be complex issues. In addition to losing eligibility, there are two other scenarios that may qualify you for Special Enrollment:

    • In states that did not expand Medicaid, you may qualify for Special Enrollment if a change in income now qualifies you for tax credits. This may also apply if you move between states.

    • You applied for Medicaid or CHIP during the Open Enrollment period, but were denied eligibility after the deadline. You may qualify for Special Enrollment in this situation. This is true regardless of whether you applied through the Marketplace or directly with your state’s agency.
  • 8
    Extenuating Household Circumstances
    hopeful woman

    There are household events that aren’t as simple as getting married or having a baby. These complex events may qualify you for Special Enrollment. They include:

    • Experiencing domestic abuse or spousal abandonment. You will need to enroll through the Marketplace Call Center. You can enroll separately from your abuser or abandoner, even if you are married. This may qualify you for tax credits and other savings. 

    • Gaining or becoming a dependent due to a child support or other court order. You can enroll up to 60 days after the court order. Coverage will be retroactive to the date of the order.

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  1. Are You Eligible to Use the Marketplace? Centers for Medicare and Medicaid Services. https://www.healthcare.gov/quick-guide/eligibility/ 
  2. Children’s Health Insurance Program (CHIP). Medicaid.gov. https://www.medicaid.gov/chip/index.html 
  3. Dates and Deadlines for 2020 Health Insurance. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/quick-guide/dates-and-deadlines/ 
  4. Enroll in or Change 2019 Plans — Only with a Special Enrollment Period. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/ 
  5. FAQs Health Insurance Marketplace and the ACA. Kaiser Family Foundation. https://www.kff.org/health-reform/faq/health-insurance-marketplace-aca/  
  6. Get Read to Apply for 2020 Coverage. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/apply-and-enroll/get-ready-to-apply/ 
  7. Getting Your Own Health Coverage When You Turn 26. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/turning-26/ 
  8. Health Care Options. AmeriCorps. https://www.nationalservice.gov/programs/americorps/current-members/health-care-options 
  9. Health Coverage for American Indians and Alaska Natives. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/american-indians-alaska-natives/coverage/ 
  10. How to Apply for Medicaid and CHIP. USA.gov https://www.usa.gov/medicaid 
  11. If You Lose Job-Based Health Insurance. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/have-job-based-coverage/if-you-lose-job-based-coverage/ 
  12. Medicaid Eligibility. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid/eligibility/index.html 
  13. Medicaid Expansion and What It Means for You. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/ 
  14. Special Enrollment Periods for Complex Issues. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/sep-list/ 
  15. Tips About the Health Insurance Marketplace. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/quick-guide/ 

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