Qualifying life events for health insurance

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Whether you buy your own health insurance, get your coverage through an employer or are eligible for Medicare, you probably have a dedicated time each year when you look at your health care spending, consider the plan options available to you and renew your coverage or sign up for a different plan for the upcoming year. That time is known as Open Enrollment.

However, there are several life changes that allow you to enroll in health insurance coverage or change your plan outside of Open Enrollment. These are known as Special Enrollment Periods (SEPs), and they typically follow a qualifying life event like losing your employer-sponsored coverage, turning 26 or moving.

So, what other situations count as qualifying life events? Read on to find out.

How do I know if I qualify for a Special Enrollment Period?

Generally, you qualify for a Special Enrollment Period if you’ve had significant changes to your household or residence or if you lose employer-sponsored health insurance coverage. You'll typically have 60 days before or after the event to enroll in new coverage — check your coverage documents for specific details.

Let’s take a look at specific events that may qualify you for a Special Enrollment Period.

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Types of qualifying life events that impact your health insurance

If you experience any of the following life changes, you may be qualified for a Special Enrollment Period and be able to change your coverage or enroll in a new plan.

Losing coverage

Losing your or a family member’s employer-sponsored coverage, switching jobs or becoming ineligible for previous coverage (like Medicare, Medicaid or CHIP) qualifies you for a Special Enrollment Period.

This is not an exhaustive list, and there are some special situations in which you may qualify for an SEP. It’s important to remember that none of these situations arise when you voluntarily drop coverage — unless your household income has dropped significantly or you are eligible for a premium tax credit (subsidy).

Turning 26

If you’re still on your parent’s health insurance plan, turning 26 may cause you to lose coverage and qualify for a Special Enrollment Period.

Moving

If you move to a new permanent residence outside of your plan’s service area or where new coverage options are available, you may be eligible for a Special Enrollment Period. Here’s when moving may impact your health insurance coverage and qualify you for a Special Enrollment Period.

• Moving to a new ZIP code or county.
• Moving to a new state.
• A dependent moving for college.
• Moving to the U.S. from other country or territory.
• Moving for seasonal employment.
• Leaving transitional housing.

Family or dependent changes

There are many situations where you may need to add or remove a dependent from your plan. The following scenarios are qualifying life events:

• Getting married.
• Having a baby.
• Adopting or fostering a child.
• Getting divorced or legally separating.
• The death of a dependent or policyholder.
• Your policyholder enrolls in Medicare.

Changing health insurance coverage with dependents

Any changes you make during an SEP will affect your covered dependents. Typically, dependents include your spouse or partner and the children you care for in your home. But, in special cases, you may have other family members you claim as dependents on your tax return, like an elderly parent or relative for whom you are the primary caregiver.

Shop for a new individual or family health plan

You have a limited amount of time during your Special Enrollment Period to find a new plan. Wellmark makes it easy to shop for individual or family plans and enroll when you’re ready. Compare available individual and family plans with our online tool.