Qualifying Events that Allow You Get Coverage Outside the OEP


Health insurance has become a necessity because on having health coverage, you can hassle-free and easily receive routine checkups, fill prescriptions, visit a specialist, or can handle any medical emergencies without breaking your bank. If you are aware of the health insurancesector , then you very well know that you can enroll in a health plan only during the open enrollment period. You are allowed to enroll outside the open enrollment period, only in case if you have a qualifying event that triggers your special enrollment period. On experiencing a qualifying life event, you can take advantage of a special enrollment period either to buy a new plan or to make changes to your individual health plan. The special enrollment period is of 60-day duration that starts from the date of the qualifying life event and continues for the coming 60 days.

Find below some of the qualifying life events and the options you have to obtain a new coverage

Domestic Developments

Besides development that directly results in loss of coverage, there are some events within your family like gaining or losing a member, which makes you eligible for a special enrollment period. Some of such events include:

Marriage & Divorce

Getting married or divorced often counts as a qualifying life event, making you eligible for a special enrollment period.

Having Children

Having a baby or adopting a child also count as a qualifying life event and result in a special enrollment period for you. You need to provide health insurance to your new-born kid or to your adopted child.


If death occurs in your family, then you will not require to cover that person anymore. There is also a chance that you will not have the dead person income, which you might be used to pay for the insurance premium. Due to this, the death of someone in your family with whom you share a health plan makes you eligible for a qualifying life event.

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The Loss of Coverage

There are a few incidences in life due to which you might suddenly lose your health insurance. However, there is a chance that you experienced a qualifying life event due to which you lose your coverage and become eligible for a special enrollment period to enroll in a new plan. Loss of health coverage due to below-given reasons trigger a special enrollment period:

Turning 26

According to the Affordable Care Act, you are allowed to remain on your parents’ health insurance until you reach the age of 26. It means that on turning 26, you will lose that coverage. Thus, you become eligible for a special enrollment period to get coverage for yourselves.

Increase in your Income

Government has started federal funded healthcare programs like Medicaid and SCHIP to provide health coverage to low-income individuals and families. If you qualify for any of these programs based upon your income and are having such a plan, then you will surely lose the coverage when your income increases beyond the set limit. In this case, you will become eligible for a special enrollment period to buy a health plan for yourself without any government assistance.

Losing Your Jobs

If you are a working professional, then the chance is that you must be having an employer-sponsored health plan, or if you are a student then you might be having a health plan offered from your school. Therefore, if you lose your job or drop out of school, then you will also lose your health coverage. It is also considered as a qualifying event that makes you eligible for a special enrollment period so that you can replace your coverage.

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Change of Residence 

Health insurance rules and regulations vary from state to state and sometimes even from county to county. Thus, if you move to a different state, county, or area with different zip codes, then you will be able to count this change as a qualifying life event and can qualify for a special enrollment period. Change of residence qualifying event will also be applicable if you are either a seasonal worker moving between your permanent home and your work, or a student moving between school and home, or if you are moving in or out of transitional housing.

Other Qualifying Life Events 

In addition to the above mentioned qualifying life events, some of the other qualifying life events include:

  • Change in income that also affect your coverage eligibility
  • If you obtain U.S. citizenship or any other lawful status, which you don’t have
  • If you become a member of a federally-recognized indigenous tribe
  • If you become a shareholder for the Alaska Native Claims Settlement Act Corporation
  • If you are starting or terminating service with AmeriCorps
  • On releasing from a prison
  • If you become eligible or ineligible for ACA-subsidies

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