Open enrollment is when the health insurance marketplace is open for clients to change or sign up to health insurance. However, it is possible to get health insurance outside of open enrollment if you have had a qualifying life event.
A qualifying event is an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual open enrollment period.
In the individual market (on or off-exchange), qualifying events include:
- The birth or adoption of a child.
- Marriage and/or divorce, however divorce is not always counted as a qualifying event by exchanges or insurers.
- Loss of other coverage, as long as the coverage you’re losing is considered minimum essential coverage.
- A permanent move to an area where different health plans are available. You must have had coverage prior to the move.
- A change in job or income that changes your subsidy eligibility. This only applies if you already have coverage through the exchange.
- A new job or increase in income that moves you out of the Medicaid coverage gap.
- A grandfathered or grandmothered plan’s non-calendar-year renewal.
- A spouse or family member who dies, of which you were insured under their coverage.
- Becoming a US citizen or lawfully present resident.
If you experience a qualifying event, you have 60 days to select a plan or switch to a different plan. However, in some cases, the ability to switch from one plan to another is limited during special enrollment periods. typically the coverage will be effective the first of the following month if you enroll by the 15th of the month. However, there are different effective date rules for marriage, birth or adoption of a child, and loss of other coverage.