List Of Qualifying Life Events (QLE) For Health Insurance – Forbes Advisor

Most of us count on health insurance to serve as a shield against the high cost of medical care. But what happens when you lose health insurance coverage?

Losing a health insurance plan is one of several situations that might be considered a “qualifying life event.” These kinds of life events make you eligible to buy insurance outside the open enrollment period during what’s called a special enrollment period.

What Is a Special Enrollment Period?

You usually purchase health insurance during the annual open enrollment period. The Affordable Care Act (ACA) marketplace’s open enrollment is from Nov. 1 to Jan. 15 in most states. But some people qualify for a special enrollment period during which they can purchase health insurance outside the open enrollment period.

You must have a qualifying life event to qualify for the special enrollment period. If you have employer-based insurance, you must be granted a special enrollment period of at least 30 days.

What Is a Qualifying Life Event (QLE) for Health Insurance?

A qualifying event for health insurance is a major change experienced by you or anyone in your household that makes you eligible to shop for a health care plan outside of the annual open enrollment period.

Here’s a list of qualifying life events for health insurance that may affect you or those in your household.

What are the IRS-qualifying life events?

What are the qualifying life events for employer-sponsored health insurance?

Qualifying life event rules are the same for employer-sponsored health insurance as any other type of coverage. That means if you separate from your employer for any reason—including if you quit or are fired—you’re generally eligible for a special enrollment period.

If you have a qualifying life event that makes you eligible for a special enrollment period, talk to your human resources department or health insurance company about the company’s policies.

How to Update Your Health Insurance After a Qualifying Life Event

People with an ACA marketplace plan who have a qualifying life event should go to the healthcare.gov website. The federal government recommends visiting your existing account—or creating a new account—at the HealthCare.gov website.

You can update your insurance by choosing a new plan if necessary. You also can call the federal health insurance marketplace for help.

If you have employer-based health coverage and experience a qualifying event, you should review your plan materials about how to proceed. Or you can talk to someone in your employer’s human resources department or call the phone number listed on your health insurance ID card.

You may need to provide documentation to prove that you qualify for a special enrollment period, depending on your circumstances, such as:

• Birth certificate or death certificate
• Marriage license or divorce papers
• Rental agreement or mortgage

Remember that you have a limited time to make changes and find new health insurance coverage, usually 60 days.

Coverage Options if You Missed the Open Enrollment Window and Don’t Have a Qualifying Life Event

Open enrollment for the Affordable Care Act marketplace runs from Nov. 1, 2022, to Jan. 15, 2023, in most states. Those dates are slightly different in a handful of states.

If you miss that window for open enrollment, don’t have a qualifying life event, or both, you might still have options for finding health insurance coverage.

COBRA coverage

If you lose health coverage because of losing your job or eligibility, you may be allowed to keep your current health insurance for a while longer. This is thanks to provisions under the Consolidated Omnibus Budget Reconciliation Act, more commonly known as (COBRA).

COBRA insurance typically requires that you pay 100{a652ac39cb023ff8fd1cc85f4393f5b1bb70bf2f880b7bee35f712e4bd8633f7} of the premiums and don’t get any help from an employer. You may also need to pay a small administrative fee to keep your current health plan for a period of 18 to 36 months, depending on why you lost coverage.

COBRA pros

• You get to keep your employer-based group health insurance plan, which typically offers robust coverage.
• You don’t have to start a new deductible with another health plan.
• You’re assured that you keep the same provider network.

COBRA cons

• The main negative is significant: COBRA coverage can be quite expensive compared to other health insurance options.

Short-term coverage

Short-term health insurance is meant to offer temporary coverage during periods when you might be between traditional health insurance plans, such as between jobs.

Coverage only lasts a year (with the chance to extend by two more years) in most states, and there is no guarantee the insurer will renew the policy, particularly if you develop a health condition.

Short-term health insurance pros

• Low premiums
• Cheap solution to a coverage gap, such as between jobs
• You can buy a plan at any time and don’t have to deal with an open enrollment period.

Short-term health insurance cons

• Limited benefits and coverage
• Higher out-of-pocket costs when you need care
• Insurance companies can reject you based on health.

Medicaid

Medicaid is government-run health insurance administered by individual state governments that follow federal requirements. It covers more than 82 million Americans.

Not everybody is eligible for Medicaid coverage. Those who qualify include:

• Low-income adults
• Children
• Pregnant women
• Elderly adults
• People with disabilities

Medicaid pros

• You may pay little to nothing for coverage based on your household income.
• Comprehensive coverage that also includes dental benefits for children and may include that care for adults, too.

Medicaid cons

• Not everyone qualifies for Medicaid.
• Health care providers may not accept Medicaid as commonly as other types of standard health insurance.

When to Buy COBRA Insurance

You may choose COBRA health insurance if you like your health plan and want to make sure you keep the same provider network. Those benefits must outweigh having to pick up all the health insurance costs.

Another time when going with COBRA insurance may make sense if you have a condition requiring a provider in your current plan’s network but who is difficult to find in other plans.

A COBRA alternative is the ACA exchange, which may offer more affordable coverage if you qualify for advanced premium tax credits. Those who qualify for those credits must have a household income under 400{a652ac39cb023ff8fd1cc85f4393f5b1bb70bf2f880b7bee35f712e4bd8633f7} of the federal poverty level. That’s $54,360 or below for a single person, $73,240 for a two-person family and $92,120 for a three-person family.

Qualifying Life Events FAQ