Qualifying Event (Health Insurance): What It Is and How It Works

What is a qualifying event?

A qualifying event (also called a qualifying life event) is a change in personal circumstances that lets you enroll in or change health insurance outside the regular open enrollment period. Without a qualifying event, you generally must wait for the next open enrollment to make coverage changes.

Common qualifying events include:
* Birth or adoption of a child
* Marriage or divorce
* Death of a spouse
* Loss of existing health coverage (for example, job loss or losing student coverage)
* Turning 26 and losing eligibility under a parent’s plan

How qualifying events work

When a qualifying event occurs, most insurers and marketplaces provide a Special Enrollment Period (SEP). During an SEP you can enroll in a new plan or change your current coverage outside open enrollment.

You typically must:
* Provide proof that the qualifying event occurred (for example, a birth certificate or marriage/divorce documentation).
* Request changes within a limited window—commonly within 60 days of the event—though exact deadlines vary by insurer and program.

Special considerations: employment and COBRA

If you lose employer-sponsored coverage, COBRA may let you continue that group plan temporarily. Key points:
* COBRA allows continuation of employer group coverage for a limited time (typically up to 18 or 36 months, depending on circumstances).
* Under COBRA you generally pay the full premium yourself, so costs are often higher than when employed.
* COBRA is a temporary solution; you can also use the loss of coverage as a qualifying event to enroll in other plans.

Real-world example: the ACA and age 26 coverage

Under the Affordable Care Act, young adults can remain on a parent’s health plan until they turn 26. Turning 26 is a qualifying event that enables those individuals to sign up for their own coverage.

Losing coverage for reasons such as job loss or end of student health plans is also recognized as a qualifying event.

Open enrollment windows (examples)

• Medicare Open Enrollment: Oct 15 – Dec 7 each year. Coverage changes take effect Jan 1.
• Health Insurance Marketplace: Open enrollment begins Nov 1. To have coverage start Jan 1, enroll by Dec 15; to have coverage start Feb 1, enroll by Jan 15.

Check the specific program or insurer for exact dates and deadlines, which may change year to year.

Options if you missed open enrollment

If you missed open enrollment and do not qualify for an SEP, possible options include:
* Applying for Medicaid if you meet eligibility rules (Medicaid enrollment can be year-round in many states).
* Purchasing short-term health insurance to bridge coverage until the next open enrollment period.

Bottom line

A qualifying event lets you enroll in or change health insurance outside of open enrollment when a major life change affects your coverage needs or eligibility. Common events include birth or adoption, changes in marital status, loss of coverage, and aging off a parent’s plan. Act promptly after an event—provide required documentation and meet insurer-specific deadlines to take advantage of a Special Enrollment Period.