What Are Qualifying Events For Health Insurance?

Qualifying Life Events For Health Insurance Changes

Many people think they can sign up for health insurance whenever they need to because of health care reform.

They call us to get enrolled in a plan, and we ask them what changes have taken place in their life. They seem puzzled by the question and say nothing has changed. We then have to explain to them why they don’t qualify to sign up for coverage.

There are qualifying life events that enable you to get health insurance outside the open enrollment period. We’ll show you what they are, and how you can use them to sign up for coverage.

There is one additional way to get coverage at any time during the year, and that option is introduced in a recent post “A New Alternative To Obamacare Is Here.”

You Can’t Enroll After Open Enrollment, unless…

Why Can’t I Enroll In Health Insurance At Any Time?

Massachusetts tried this when their “Romneycare” plan was introduced in 2006. What some people did was wait until they needed care, and then they signed up for health insurance. Once they were healed, they dropped the coverage. This caused health insurance premiums to rise faster than they should have.

In 2010 Massachusetts created an open enrollment period to prevent people from “gaming” the system.

Obamacare avoids this problem by starting with an open enrollment period. Once the window closes, there are only selected situations that allow someone to enroll for coverage. These are called Qualifying Events, and create a Special Enrollment period.

Special Enrollment Qualifying Events

The following qualifying events create a special enrollment period that lasts for 60 days from the event. During this 60 day window you can enroll in coverage, and in some cases change existing coverage.

The qualifying events are:

Involuntary loss of Minimum Essential Coverage (MEC)

Due to losing an employer-sponsored health plan
The expiration of your Cobra coverage

Give birth or adopt a child
Get married or divorced
Become a citizen, a national or a lawfully present individual
There was an unintentional, inadvertent or erroneous mistake in your CoveredCA enrollment that prevented you from getting coverage, or caused you to be enrolled in the wrong plan
You can prove to CoveredCA that the CoveredCA Health Plan in which you are enrolled substantially violated a material provision of its contract with you
You become newly eligible or ineligible for subsidy assistance or Cost Share Reduction benefits, if you are already enrolled in CoveredCA
Existing company-sponsored health insurance won’t be considered affordable or provide MEC at annual renewal time
New resident of California due to permanent move, or a resident moving to a location where new coverage is available
You become eligible or ineligible for Medi-Cal
Native Americans can enroll at any time, or change to another plan once each month
You are released from incarceration

A special note for number 1 above is that you can not cancel your existing plan, or lose coverage by not paying the premium, and then sign up for new health insurance.

The qualifying events that will occur most frequently are having a baby, getting married, losing group or COBRA coverage, becoming a naturalized citizen, or moving to California.

If you forget to enroll for coverage during the open enrollment period, know that it will be much harder to get health insurance after open enrollment. Should one of the qualifying events happen later this year, then contact us and we’ll help you through the paperwork to enable your special enrollment period, and to prove the existence of your qualifying event.

For everyone else, we’ll talk to you during the next Open Enrollment period.

Go to the Obamacare Impact On Individuals and Families page.