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Special Enrollment Periods and Qualifying Life Events

Last updated June 24th, 2020

Reviewed by Garrett Ball

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Those of us with life changes – or “Qualifying Life Events” – can skip the line when it comes to joining a health insurance plan. QLEs automatically grant you a 60-day Special Enrollment Period to enroll in health insurance during any time of the year.

Your Qualifying Life Event (QLE) immediately begins a Special Enrollment Period (SEP) once it occurs. When you enter that Special Enrollment Period, you or your family can pick a new comprehensive health plan without penalty. You can also change your existing healthcare coverage.

Several states have re-opened insurance plan sign-ups due to the coronavirus pandemic. They include the following: 

qualifying life event categories | What is a QLE? | HealthCare.com

Health Insurance Qualifying Life Events:

Any one of these Qualifying Life Events opens the door to health insurance coverage adjustments if you choose.

If you’re looking for health insurance on HealthCare.com outside of open enrollment, you’ll be asked which QLE you have. Without a Special Enrollment Period, your health insurance options will be limited.

In an ideal world, you’d sign up for health insurance within the winter open enrollment window, generally November 1 through December 15 each year. Health insurance companies aren’t allowed to enroll you outside of the open enrollment window without one of these good reasons. Fortunately, there are many ways to get a Qualifying Life Event.

You Have 60 Days to Use Your Special Enrollment Period (SEP)

Your Special Enrollment Period generally lasts for 60 days, starting from the day of your QLE.

Your policy will generally be effective on the first day of the month following your application, regardless of what date you complete your application.

Countdown Begins on the Day: Your Special Enrollment Period is a 60-day health insurance enrollment window. It begins on the day your qualifying life event takes place.

This means that if you get married on May 31, you must enroll in a new health insurance plan before the end of July. If you quit your job to form your own business, you have 60 days from the last day of employment to get new healthcare coverage. Once the 60-day window has passed, you have to wait until the regular Open Enrollment Period to obtain health insurance coverage or update your current coverage. Some SEPs Are Truly Special: Additional QLE protections may apply, depending on your QLE circumstances. For example, if you have a baby, adoption, or foster care relationship, you can enroll in an ACA health plan for up to 60 days after the event and coverage can start the day of the event. Check the list above for more details.

Coronavirus: The coronavirus pandemic has also triggered a QLE for millions of uninsured Americans. Several states have reopened sign ups at this time. They include the following along with the deadline to enroll:

  • California: June 30
  • Colorado: April 3
  • Connecticut: April 2
  • Maryland: April 15
  • Massachusetts: April 25
  • Nevada: April 15
  • New York: April 15
  • Rhode Island: April 15
  • Washington: April 8

Also, residents of Washington, D.C. have an ongoing SEP for non-coronavirus reasons. The sign-ups end on April 15 for Washington, D.C.

If You Don’t Use Your Special Enrollment Period: You don’t have to change your health insurance if you don’t want to. If you lost your plan, however, you may be able to sign up for temporary health insurance. If you were incapacitated for part of the 60 days, you may be able to claim an additional SEP with the help of a health insurance agent.

Affordable Care Act administrators have specified that a lack of knowledge about COBRA is not a qualifying life event. In general, you cannot claim a Special Enrollment Period solely because you were not aware of your SEP. It’s still possible to get health insurance after open enrollment, even without a qualifying life event.

No Penalties for Using a Special Enrollment Period: If you use Special Enrollment, you will not pay additional monthly premiums. Affordable Care Act insurance plans must accept your application, just as if you were applying during open enrollment.

Everyone’s Special Enrollment Period Is Unique: Since the Special Enrollment Period is not a specific time period, your special enrollment will be different than someone else’s. Although you can figure out your own SEP, it’s not a recurring event.

Special Enrollment for Unrelated Products: Taxes and other healthcare items may promote their special enrollment periods. These are not the same as Special Enrollment Periods for Affordable Care Act plans.

You Don’t Need a QLE Reason to Join During the Open Enrollment Period

The next health insurance Open Enrollment Period will begin again on November 1, 2020.

If you somehow missed all our emails about open enrollment, you could be stuck without health insurance for the next year. Mark your calendar for the insurance enrollment season.

Don’t Wait to Change Coverage

Changes in life happen every day. Many times when these life events occur, your health insurance plan is the last thought on your mind. However, not having enough insurance coverage can be physically and financially dangerous should an unexpected accident occur.

Without making a change in time, you could be without any coverage and won’t be able to add it when you need it. Make sure changing your health insurance policy does nothing but bring you peace of mind.

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