What Do Qualifying Events Have to Do With Health Insurance?

What Do Qualifying Events Have to Do With Health Insurance?

July 14, 2016
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In my role as a financial adviser, I talk to people about risk. Investing and saving are familiar tools for protecting yourself from financial risk. But we all face another kind of risk - accidents and the cost of a serious injury. Without a health insurance plan, even if you're healthy, you face serious financial risk. 


If you don’t currently have a health insurance plan, you may be eligible for coverage through one of the Affordable Care Act’s health insurance marketplace exchanges. You can apply for health insurance through one of these health exchanges during a short time each year called the special enrollment period.

However, if you miss this enrollment window, you have to wait until it reopens the next year. There are plenty of reasons that people don't apply during the designated period. Unfortunately, missing the enrollment period and going without health insurance has these two consequences:

1) You receive a tax penalty for not being insured
2) You could have a medical emergency where insurance is necessary to help pay the medical bills

To avoid both of these issues, you can claim a qualifying life event, and apply for health coverage outside of the normal window.  

What Are Qualifying Life Events For Health Insurance?

A qualifying life event is any event that has altered your life in a significant way. These include but are not limited to: 

  • Marriage or divorce
  • Death of a spouse
  • Birth of a child
  • Your spouse losing his/her job

Other eligible events include changing your permanent place of residence, experiencing an increase in income that makes you ineligible for Medicaid, or beginning or ending service with Americorps. The list of qualifying events is broad and extremely varied, so it’s a good idea to do a little investigation to find out whether or not you may be eligible for the special enrollment period. 

The Special Enrollment Period for Qualifying Life Events

Usually, the length of the special enrollment period is 60 days. The process for applying is the same as during the regular enrollment period; you can choose among multiple health plans in the marketplace, or outside of the marketplace, depending on your income. 

If you choose a plan during the first half of the month, then your insurance coverage will begin on the first day of the following month. If you pick a plan during the second half of the month, then your coverage will begin on the first day of the second month. 

A qualifying life event for health insurance gives you the opportunity to apply for coverage outside of the regular enrollment window. If you have recently undergone any major changes in your life, then don’t be afraid to do a little digging; you may be surprised at just how many life events qualify you for coverage. Health insurance is not just necessary for you, but for your family members as well, so it’s important that you exhaust every opportunity to apply for it.  

If you live in Washington DC, a free service to applicants to help them navigate the process is available from DC Health Link. You can search online for a broker who is licensed to provide that help. Please feel free to contact me; I can help you understand the health insurance options and select the best plan for you. 

Have questions? Get in touch today!


Material discussed is meant for general illustration and/or informational purposes only, and it is not to be construed as investment, tax, or legal advice. Although the information has been gathered from sources believed to be reliable, please note that individual situations can vary. Therefore, the information should be relied upon when coordinated with individual professional advice.