We know that the best time to get health insurance is during Open Enrollment. However, certain circumstances or “qualifying life events” permit you to get coverage outside the standard enrollment period.
Not every event is considered a qualifying life event, so read on, and we’ll cover all the instances when you can access a Qualifying Open Enrollment Period.
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Under normal circumstances, to purchase or make changes to your health insurance plan, you must do it during Open Enrollment. However, circumstances or qualifying events allow you to buy a life insurance policy or change your existing policy beyond the Open Enrollment Period window.
Not all health insurance providers recognize qualifying life events. For example, ACA-compliant medical plans recognize qualifying life events such as marketplace, group coverage, or semi-compliant grandfathered plans.
However, if you experience a qualifying life event, short-term medical plans won’t allow you to make changes to your coverage.
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When you experience a qualifying life event, it triggers a Special Enrollment Period that lasts 60 days after your event. The Special Enrollment Period (SEP) is what grants policyholders access to their ACA-compliant health insurance.
Be sure to make changes within the 60-day window; otherwise, you’ll lose the opportunity to access ACA-compliant health plans. Although, you can still apply for Medicare (if applicable) or purchase health coverage through insurance.
In order to be eligible to make changes to your health insurance, you still need proof of your claims — documentation — that you can give to your insurer.
How it works is you’ll pick your health insurance policy (or make changes), and then you must get the documentation to your provider within 30 days. However, your policy will not come into effect until after you’ve paid your premium, your eligibility is confirmed, and your qualifying event is confirmed.
It’s important to note that you don’t need a qualifying life event to cancel your health insurance coverage. However, bear in mind that if you cancel your plan, you can’t enroll until the next Open Enrollment period.
Unfortunately, group coverage requires you to have a qualifying life event to cancel your coverage; or you’ll face tax penalties under section 125 of the Internal Revenue Code.
You never want to be without health insurance, so it’s important to know the special circumstances that allow you to access your ACA-compliant health plan if you need to make adjustments to your policy.
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Jessica Fox Jessica Fox has been a freelance writer for five years, with a specialty in health, wellness, and insurance. During this time, she’s written for some of the biggest B2B and B2C brands from around the world. Jessica is also the mother of two young daughters and loves coffee, writing, and working out.
