Note: this post was originally published on May 12, 2014 but has been updated for 2015. What appears here is the updated information, as of March 2015.
When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment. A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event. Read more about special enrollment periods.
Examples of Qualifying Events
- Change in marital status (marriage/divorce/death of a spouse)
- Relocation to a new state or to an area of your current state where the plans offered are different
- Change in family size (birth/adoption/death of a child)
- Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)
- Certain changes in income
- Expiration of COBRA benefits
Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:
- A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.
- An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.
- If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.
- If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.
What Should You Do if You Have a Qualifying Event?
If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan. When applying for coverage, you will need to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.
If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you will need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).
If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:
But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.
Give our office a call at 703-707-8270 and we’d be glad to help.