Qualifying Life Events for Insurance

Health insurance helps bring down the cost of medical care from regular checkups to major procedures, making it crucial to protecting you and your loved ones. While most people can only enroll in a new health plan during open enrollment of each year, significant changes in circumstances — called qualifying life events — may make you eligible to enroll in health coverage outside open enrollment.¹ Read on to learn more about qualifying life events for insurance in more detail and several types of events so you can see if you qualify for a special enrollment period.

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What is a qualifying life event for insurance?

A qualifying life event for insurance is a major change in your circumstances that can impact your insurance needs. A qualifying life event makes you eligible for a special enrollment period outside regular health insurance enrollment so you can shift to a new plan that fits your new needs.

Types of qualifying life events

Numerous changes may count as qualifying life events, including:²

Getting married

Getting married substantially impacts your financial and legal status since you may now have to provide coverage for your spouse. Therefore, you’re allowed to take advantage of a special enrollment period.

Getting divorced

Divorce alters your coverage needs as significantly as marriage since you might no longer need coverage for your former spouse. This counts as a qualifying life event, so you can get a plan with less coverage to help save on premiums.

Having or adopting children

Having or adopting children is a qualifying life event since you must provide them with coverage. A special enrollment period lets you select a plan that covers your children's needs.

Turning 26

When you turn 26, you can no longer remain on your parent’s health insurance. So, turning 26 is a qualifying life event, allowing you to shift to your own plan.

Turning 65

Once you turn 65, you qualify for Medicare coverage. However, seniors may need more health coverage than younger individuals. Therefore, you can change your health plan during a special enrollment period at age 65, whether you’re increasing or decreasing your private coverage outside Medicare.³

Employment status change

Many insurers offer health coverage as part of their benefits packages, so changing your employment status is a qualifying life event. For example, if you get laid off, you may eventually lose workplace coverage when COBRA ends. Therefore, you can get a chance to enroll in a new plan outside the regular enrollment period. Keep in mind that changing jobs within an organization, such as through a promotion, does not count as a qualifying life event.

Address change

Health insurance varies widely by area, so moving to a new address can be a qualifying life event. What qualifies as a new area can depend on your area's health insurance regulations. In general, moving to a new ZIP code may qualify you for the special enrollment period.

Other qualifying life events

Here are some other qualifying life events:

Losing Medicare, Medicaid, or CHIP coverage eligibility
Losing health coverage for changes in student status, if relevant
Income changes that impact coverage qualifications
Becoming a U.S. citizen
Leaving incarceration
Death in the family

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What to do if you experience a qualifying life event

If you experience a qualifying life event, here’s what to do:

1. Check your insurance plan: Look over your current policy to see the rules and deadlines for reporting a qualifying life event to the insurer and anyone else.

2. Gather necessary documentation: Gather documents proving the change, such as marriage certificates, proof of address change, birth certificates, divorce decrees, layoff notification, or a notification of a loss of coverage.

3. Notify your health insurance company: Tell your insurer about your qualifying life event as soon as possible.

4. Explore your options: Compare health insurance plans through your insurer and the health insurance marketplace. Consider the premiums, coverage, providers covered, deductibles, and other relevant factors.

5. Apply for your chosen plan: Apply for the plan that fits your needs. Submit any necessary documentation to prove the qualifying life event.

6. Confirm your enrollment and start date: When approved, confirm your effective start date to ensure new coverage starts before or when your old coverage ends.

7. Pay your first premium: Once your new coverage starts, you’ll pay your first premium. You can set up automatic payments if needed.

8. Inform your health providers and find new ones if needed: Contact your providers to inform them of your new coverage to ensure proper billing. Additionally, you may need to find new providers in case your covered providers have changed.

How much time do I have to make changes after a qualifying life event?

After you experience a qualifying life event, your special enrollment period may last 30 to 60 days after the event, for Marketplace health plans.⁴ Many individual market plans are on the higher end of that range. Workplaces must also provide a special enrollment period of at least 30 days after any qualifying event.⁵ Regardless, it’s important to act fast. If you don’t enroll in a new plan during this period, you must wait until open enrollment.

Get a quote for Aflac supplemental health insurance 

Insurers understand that life can change, and so can your health insurance coverage needs. So, life events like marriage, divorce, having children, turning 65, and more allow you to change coverage outside the normal open enrollment period so you can get coverage that suits your unique situation.

If you need additional coverage, you can apply for a supplemental insurance policy through Aflac. We offer a variety of plans, including critical illness, accident, life, and dental insurance. Chat with an agent today to explore our array of options and get a quote.

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