Most people know that Open Enrollment is the window to sign up for health insurance each year. What fewer people realize is that certain life changes give you the right to enroll in coverage any time of year, no matter where you are on the calendar.
These changes are called qualifying life events, and if you’ve recently experienced one, you may have more options than you think.
What Is a Qualifying Life Event?
A qualifying life event is a significant life change that affects your health insurance situation. When one of these events occurs, it triggers a Special Enrollment Period that allows you to apply for, change, or drop health insurance coverage outside of the standard Open Enrollment window, which runs November 1 through January 15 each year for ACA Marketplace plans.
The Special Enrollment Period is typically 60 days from the date of the qualifying event. Miss that window and you generally have to wait until the next Open Enrollment Period unless another qualifying event occurs.
Life moves fast in your twenties and thirties. Jobs change, relationships change, families grow, and people move. Any of those transitions can trigger a qualifying event and open a window to revisit your coverage. Here is what you need to know about the most common ones.
Getting Married
Marriage is a qualifying life event. The two separate health insurance plans that made sense when you were single may no longer be the right fit once you are a household. One spouse may have better employer coverage than the other. One may not have coverage at all. Or combining onto a single plan may simply be more cost-effective than maintaining two separate ones.
Marriage gives you 60 days from the date of the wedding to purchase a new plan or make changes to an existing one. During that window it is worth comparing your options carefully, including whether one spouse’s employer plan, an ACA Marketplace plan, or a combination of the two makes the most sense financially and in terms of coverage.
If you qualify for premium tax credits on the Marketplace, your new combined household income will factor into what you are eligible for, so it is worth running the numbers before assuming your pre-marriage options still apply.
Having or Adopting a Child
The birth or adoption of a child is a qualifying life event. A plan that worked well for you before may not be the right fit for a growing family, and the arrival of a new child is the right moment to review whether your current coverage meets everyone’s needs, including pediatric care, well-child visits, and any specialists your child may need.
You have 60 days from the birth or adoption date to enroll in a new plan or add your child to an existing one. One important note: if you are enrolling a newborn in a Marketplace plan, coverage can be backdated to the date of birth even if you apply later within the 60-day window. That backdating does not always apply in other qualifying event scenarios, so it is worth confirming the effective date when you enroll.
Losing Job-Based Coverage
Losing employer-sponsored health insurance is a qualifying life event, whether you were laid off, your employer stopped offering coverage, or your hours were reduced below the threshold that made you eligible for benefits.
One important distinction worth understanding: getting a new job is not itself a qualifying event. The trigger is the loss of existing coverage, not the gain of new employment. If you left a job voluntarily and lost coverage as a result, you still qualify for a Special Enrollment Period. However if you voluntarily dropped your employer plan while still employed without actually leaving the job, you would not be eligible for a Special Enrollment Period through the Marketplace.
If you lose job-based coverage, you have 60 days to enroll in a Marketplace plan or other qualifying coverage. During that window it is worth comparing Marketplace options against COBRA continuation coverage, which allows you to temporarily stay on your former employer’s plan but requires you to pay the full premium including the portion your employer previously covered.
Turning 26
Turning 26 is a qualifying life event. Under the Affordable Care Act, young adults can remain on a parent’s health insurance plan until age 26. Once that birthday arrives, coverage ends, and you are responsible for finding your own plan.
Because birthdays fall throughout the year and not just during Open Enrollment, turning 26 triggers a Special Enrollment Period giving you 60 days to enroll in new coverage. If you apply before your 26th birthday, coverage can start as early as the first day of the month your parental coverage ends. If you apply during the 60 days after your birthday, coverage typically starts the first day of the month after you select a plan.
Many people in their mid-twenties qualify for significant premium subsidies on the Marketplace depending on their income, so it is worth checking eligibility before assuming coverage will be unaffordable.
Moving to a New Coverage Area
Moving to a new state or a new county within Virginia can also trigger a Special Enrollment Period, particularly if your current plan does not cover your new location or if different plans are available in your new area. ACA Marketplace plans are county-specific, meaning what is available in Fairfax County differs from what is offered in Loudoun or Prince William County.
If you are moving within Virginia or relocating to Virginia from another state, check whether your current coverage follows you or whether you need to enroll in something new. A move is also a good opportunity to shop your options even if your current plan technically covers your new area, since local plan availability and pricing can vary significantly.
Other Qualifying Events
The events above are the most common, but the list does not end there. Other qualifying life events include:
Losing coverage through Medicaid or CHIP. A change in income that affects your subsidy eligibility. Becoming a United States citizen or lawfully present resident. Leaving incarceration. A change in your dependent status. Certain errors or delays in enrollment through the Marketplace.
If something significant has changed in your life and you are not sure whether it qualifies, the answer is almost always worth checking rather than assuming.
The 60-Day Window Matters
Every qualifying life event comes with a limited window, typically 60 days, to act. Once that window closes, your next opportunity to enroll in or change coverage is generally the following Open Enrollment Period. For most people that means waiting months, which is a long time to go without coverage or to stay on a plan that no longer fits your life.
If you are inside a Special Enrollment Period right now, the most important thing you can do is not wait until the deadline is close. Options take time to compare, and enrollment can take a few days to process.
How The Stern Team Helps
Qualifying life events often happen during already busy and stressful periods of life. A new baby, a job change, a move, a marriage. The last thing most people want to do in the middle of a major life transition is spend hours comparing health insurance plans on their own.
The Stern Team helps Virginia individuals and families navigate qualifying life events and find the right coverage at no cost. We compare every option available in your area, check subsidy eligibility, verify that your doctors and prescriptions are covered, and walk you through enrollment from start to finish.
If you have recently experienced a qualifying life event or think you may be inside a Special Enrollment Period right now, call us before the window closes.
(703) 969-1811
jeremy.stern@healthmarkets.com
The Bottom Line
Open Enrollment is not the only time you can get covered. Major life changes open a 60-day window to enroll in or change health insurance outside the standard schedule. If you have recently gotten married, had a child, lost job-based coverage, turned 26, or moved to a new area, you may have more options available right now than you realize. The key is acting before the window closes.
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