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Questions about your Eligibility based on my State or Situation

If you have Questions about your Eligibility based on a State or Situation

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Written by Amanda Roberts

Open Enrollment runs November 1 through December 15, and during this window, anyone can shop for an individual health insurance plan, with coverage starting January 1.

Outside of that window, you'll need a Qualifying Life Event (QLE) to enroll in or change an individual health insurance plan — unless your state runs an extended Open Enrollment period. You can check to see if your state' has an extended open enrollment here: Need health insurance? | HealthCare.gov

Qualified Life Events:

Loss of qualifying health coverage

  • Losing job-based coverage (including through a spouse or parent)

  • Aging off a parent's plan at 26

  • Losing Medicaid or CHIP eligibility

  • Losing individual/marketplace coverage for a reason other than not paying premiums

  • COBRA coverage ending

Household changes

  • Getting married

  • Divorce or legal separation (in states where it affects coverage eligibility)

  • Having a baby, adopting a child, or placing a child for foster care

  • Death of someone on the policy

Residence changes

  • Moving to a new ZIP code or county where different plans are available

  • A student moving to or from school

  • A seasonal worker moving to or from where they live and work

  • Moving to or from a shelter or transitional housing

ICHRA and QSEHRA specific

  • Becoming newly eligible for an ICHRA or QSEHRA — this is itself a QLE. Employees (and their dependents) get a 60-day SEP from their HRA eligibility date to enroll in or change an individual health plan.

  • A change in HRA affordability or offer terms that affects marketplace subsidy eligibility

Other qualifying changes

  • Gaining U.S. citizenship or lawful presence status

  • Release from incarceration

  • A change in income or household size that affects subsidy eligibility

  • A plan or issuer violation of its contract

  • An exceptional circumstance (natural disaster, serious medical condition, etc.) recognized by the exchange

If you do have a QLE you can shop for 60 days from the date of the event.

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