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Your guide to qualifying life events
By Aetna
In the midst of a major life change, your health care plan shouldn’t keep you up at night. To suit your new needs, certain circumstances — called “qualifying life events” — may allow you to add or subtract the people on your plan or even change the plan itself.
Open enrollment isn’t the only time you can update your health insurance coverage. Read on to learn more about four times when you may be able to change your coverage, or watch the video below, which covers the article’s highlights in just 60 seconds.
Health care answers in 60 seconds.
When can I change my health plan?
Typically, you sign up for a new health plan during open enrollment. But you may also change your plan under special circumstances called qualifying life events.
Here are common events.
- Loss of insurance.
- If you lose coverage because you've aged out of your parents' plan, lost your job, or switched your job, you qualify.
- Change in household.
- If you get married, have a baby, or when the number of people in your family changes, you qualify.
Health care question answered.
Aging out: Max looks forward to his 26th birthday.
Max is a graphic designer at a Philadelphia magazine. Though his employer offers health coverage, Max found it easier to remain on his parents' health plan. But after he turns 26 in several months, he won’t be eligible for his parents' coverage anymore. Because aging out of your parents' plan is a qualifying life event, Max can enroll in his employer's plan the day after his parents’ coverage ends (either on his birthday or the last day of the calendar month). He'll now have to pay for his own coverage, but he's glad he has access to quality health care.
Other types of health coverage loss include:
- Losing existing health coverage, including job-based, individual, and student plans
- Losing eligibility for Medicare, Medicaid, or CHIP
Death in the family: Lisa starts a new chapter.
Lisa, 53, recently lost her husband, James, to a heart attack. Her friends have been great about checking in on her and lifting her spirits. They’ve also helped her update financial accounts and other practical matters. Before James' death, for instance, Lisa was covered under his employer’s health insurance plan. Now, Lisa no longer qualifies for that plan.
In cases like Lisa's, surviving spouses are entitled to COBRA coverage, but Lisa chooses another option. Since the death of a spouse is a qualifying life event, she can enroll in her employer’s health plan. Under her new coverage, she finds a counselor who helps her cope with her grief and look to the future with hope and gratitude.
Other changes in household include:
- Getting married or divorced
- Death in the family
- Having a baby or adopting a child. (Read more about this below.)
Having a baby: Javier adopts a little girl.
Javier, 38, and his husband live in Miami, Florida. They just adopted a three-month-old girl, Lucía, and want to give their daughter the best of everything. Right now, Javier’s high-deductible health plan only covers him and his spouse. But he can easily change that. When you welcome a child to your family through birth or adoption, that’s considered a qualifying life event. After he brings Lucía home, Javier contacts his health plan to inform them of the event and chooses a lower deductible plan suitable for his entire family.
Read more about adding a new baby to your plan.
Change of residence: Gwen moves her family across the country.
Gwen, 46, is a single mom three boys in Raleigh, North Carolina. She just got some great news: Her employer has offered her a promotion overseeing a large sales force in Los Angeles. Her current plan features a robust network of health care providers in Raleigh, but none in Los Angeles. While not every change in residence is considered a qualifying life event, Gwen’s move outside her plan’s service area is. Gwen notifies her human resources department that she'd like to switch health plans so that finding covered providers near her new home won't be a challenge.
If you’ve got questions about health savings accounts, read all about FSAs and HSAs.
Other changes in residence include:
- Moving to a different ZIP code or county
- A student moving to or from the place they attend school
- A seasonal worker moving to or from the place they live and work
- Moving to or from a shelter or other transitional housing
Key takeaways about qualifying life events
The bottom line is, you might not need to wait for your employer or the government's next open enrollment period to make changes to your health plan. Here's what else you should know:
- To make changes to your health plan, you must be experiencing a “qualifying life event.” If you’re not sure an event qualifies, visit Healthcare.gov or contact your current or future health plan sponsors (such as your employer) for more specific information.
- Qualifying life events trigger a "special enrollment period" that typically lasts 30 to 60 days, depending on your plan, during which you can select a new plan or add a new dependent to your plan.
- To change your plan selections, notify your current or future health plan sponsor of the qualifying event in your life as soon as possible.
- Other qualifying life events include getting married, losing coverage due to divorce, losing eligibility for Medicaid, and exhausting your COBRA coverage.
- Different plans have different rules. Contact your plan administrator about any change in status that impacts your health coverage to find out your rights.