Table of Contents
- What Is a Qualifying Event?
- How Qualifying Events Work
- Important Details on Proof and Timing
- Special Considerations
- Real-World Example of a Qualifying Event
- When Is Open Enrollment for Medicare?
- When Is Open Enrollment for the Health Insurance Marketplace?
- Can You Sign Up for Insurance After Open Enrollment?
- The Bottom Line
What Is a Qualifying Event?
Let me explain what a qualifying event means for you. It's a change in your life circumstances that lets you alter your existing health insurance policy or sign up for a new one, even if it's not during the open enrollment period.
Without one of these events, you'd have to wait for the next open enrollment to make any changes. Common examples include the birth or adoption of a child, the death of a spouse, or a change in your marital status.
Key Takeaways
- A qualifying event lets you change your health insurance policy or enroll in a new one outside of open enrollment periods.
- Open enrollment usually happens at the end of the year, with coverage starting the following year.
- Examples include birth or adoption of a child, death of a spouse, or marital status changes.
How Qualifying Events Work
In the United States, most health care comes from private insurance plans, with the rest covered by programs like Medicare and Medicaid. You might get insurance through your employer, who often pays part of the premiums, or you can buy a plan via the Health Insurance Marketplace.
You typically pick your coverage during open enrollment at the end of the year, with it starting the next year. For the Marketplace, that's usually November to mid-December. After that, no changes unless you have a qualifying event.
These events, also called qualifying life events, are big changes like getting married, divorced, having a baby, adopting a child, or losing a spouse. Your insurance policy likely has rules that trigger a special enrollment period if this happens, so you can request changes without waiting.
Important Details on Proof and Timing
You generally need to prove the event with documents like a birth certificate, marriage license, or divorce papers. Once accepted, you have to request coverage changes within 60 days in most cases.
Special Considerations
Job changes are handled differently. If you leave or lose your job, COBRA lets you stay on your employer's group plan. This law from 1985 keeps your coverage going.
But with COBRA, you pay the full premium, which is higher since your employer no longer contributes. It's temporary, usually lasting 18 to 36 months depending on the situation.
Real-World Example of a Qualifying Event
The Affordable Care Act, or Obamacare, expanded what counts as a qualifying event. For instance, you can stay on your parents' plan until age 26, and turning 26 triggers eligibility for your own coverage.
Losing coverage from a job or as a student also qualifies under the ACA.
When Is Open Enrollment for Medicare?
Medicare open enrollment runs from October 15 to December 7 each year. Coverage starts January 1 and runs through December 31 of the next year.
When Is Open Enrollment for the Health Insurance Marketplace?
Marketplace open enrollment starts November 1. Enroll by December 15 for January 1 coverage, or by January 15 for February 1 coverage.
Can You Sign Up for Insurance After Open Enrollment?
If you miss open enrollment, you might still enroll based on your situation. Qualifying for Medicaid could allow special enrollment, or you can get short-term insurance until the next period.
The Bottom Line
Health insurance from employers, Medicare, or the Marketplace has open enrollment for signing up or changing coverage. Outside that, you need a qualifying event like marriage, divorce, childbirth, adoption, job change, or similar life shifts.
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