- What qualifies as a qualifying life event for insurance?
- How a qualifying life event special enrollment period works
- Who is eligible for a qualifying life event special enrollment period?
- What kind of documents do you need for a qualifying life event?
- What if you don't have a qualifying life event and need health insurance?
- What is an open enrollment period?
- Sources
- FAQ: Qualifying life events for health insurance
What qualifies as a qualifying life event for insurance?
Qualifying life events include marriage or divorce, the birth of a child and losing your employer-based health insurance. They are events that are major life changes and affect your eligibility for or access to health insurance, or who can be on your plan.
The table below breaks down major life events that qualify for a QLE, examples, exceptions and what documentation is required.
| Type of event | Examples and exceptions | Documentation |
|---|---|---|
| Change in marital status | Marriage, divorce | Marriage certificate or divorce decree |
| Becoming a parent | Birth, adoption, fostering Exception: becoming pregnant (birth, not pregnancy, is a QLE) | Birth or adoption certificate, foster documentation |
| Losing your health insurance | Job loss, turning 26, losing COBRA or student health insurance. Exception: loss of coverage for non-payment of premiums | Termination letter from previous health insurer, proof of previous coverage for 26-year-olds aging out |
| Changes to eligibility | Income changes affecting Medicaid and ACA coverage, becoming a U.S. citizen, military discharge, release from incarceration, new membership in a federally recognized tribe | Income documentation, citizenship papers, discharge papers, tribal membership papers or prison release documents |
| Changes in residence | Moving to a different ZIP code, to or from school, to or from work locations for seasonal workers, or moving to the U.S. | Proof of new residence |
How a qualifying life event special enrollment period works
When you experience a qualifying life event such as the death of a spouse, birth or adoption, or moving to a different state, a special enrollment period opens for you. During special enrollment, a person can get health insurance or change coverage.
A qualifying life event can trigger a special enrollment period at any point during the year.
For an ACA marketplace plan, you can purchase a new policy or make changes to your existing policy 60 days before your qualifying life event -- or 60 days after. You have to wait until the annual open enrollment period to buy or modify coverage if your deadline passes.
To get health insurance during the special enrollment period:
- Visit your state's insurance marketplace or the federal HealthCare.gov site.
- Submit an application with your personal information and check the box for the qualifying life event you have experienced.
- After you complete the application, the site offers your health insurance plan options. You can choose a policy with your preferred coverage limit and deductible, and in most cases, you can buy a policy online.
Employer-provided health plans also have special enrollment periods when you have a qualifying life event. Check with your employer to find out how it handles special enrollment periods.
Who is eligible for a qualifying life event special enrollment period?
You are eligible for a SEP if:
- You're 26 or older
- You have experienced a QLE
- You can provide documenation
You do not need to have previous health insurance in most cases to qualify for a special enrollment period based on a QLE. However, for QLEs related to loss of previous coverage, evidence of that coverage is usually required.
What kind of documents do you need for a qualifying life event?
The documentation required depends on the type of qualifying life event. For instance:
- If you recently had a baby, the child's birth certificate would serve as sufficient proof.
- If you lost coverage through your employer, you might submit a letter of termination from your old health insurance provider.
- If you move to a new state, a utility bill with your name and address or a signed lease agreement would work.
What if you don't have a qualifying life event and need health insurance?
If you need health insurance outside of the annual open enrollment period but haven't experienced a qualifying life event, you have a few options:
- Enroll in a Medicaid plan if you meet the income requirements. Medicaid is a federally-funded health insurance program that’s reserved for low-income families. There's no open enrollment period for Medicaid, so you can purchase coverage at any time.
- Look into the Children's Health Insurance Program (CHIP). It can help you get affordable coverage outside of open enrollment if you have kids. Some state CHIP programs are rolled into Medicaid, while others are separate programs.
- Purchase short-term health insurance. These policies can be purchased in most states directly from private health insurance companies at any point during the year, without a qualifying life event. These low-cost plans have limited benefits, so it’s wise to only keep short-term health insurance until you’re eligible for a health plan with comprehensive coverage, such as an ACA or employer plan.
What is an open enrollment period?
The open enrollment period is a specific time when consumers can purchase a new individual health insurance policy or make changes to their existing policy. Open enrollment typically happens between November 1 and January 15 for ACA marketplace plans.
There are a handful of states that have longer ACA open enrollment.
Most pre-retirement members get their health insurance through an employer’s group plan. Open enrollment for those group health insurance plans varies by employer. Check with your company if you don’t know when it holds open enrollment.
Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong. Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.
ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.
Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.Health insurance finder tool
COBRA
Learn more about COBRA
How much is your annual household income?
How many members are in your household?
Medicare
Medicare costs vary depending on which option you choose.
Learn more about Medicare costs.
Medicaid
Parent's employer-sponsored health insurance
Spouse's employer-sponsored health insurance
Employer-sponsored health insurance
Preferred-provider Organization (PPOs)
Preferred-provider organization (PPOs) plans are the most common type of
employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but
those added costs offer you flexibility. A PPO allows you to get care anywhere
and without primary care provider referrals. You may have to pay more to get
out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plansHealth maintenance organization (HMO)
Health maintenance organization (HMO) plans have lower premiums than PPOs.
However, HMOs have more restrictions. HMOs don't allow you to get care outside
of your provider network. If you get out-of-network care, you'll likely have to
pay for all of it. HMOs also require you to get primary care provider referrals
to see specialists.
Find out more about the differences between plansHigh-deductible health plans (HDHPs)
High-deductible health plans (HDHPs) have become more common as employers look
to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but
much higher deductibles. A deductible is what you have to pay for health care
services before your health plan chips in money. Once you reach your deductible,
the health plan pays a portion and you pay your share, which is called
coinsurance.
Find out more about the differences between plansExclusive provider organization (EPO)
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with
the restricted network found in an HMO. EPOs don't require that members get a
referral to see a specialist. In that way, it's similar to a PPO. However, an
EPO requires in-network care, which is like an HMO.
Find out more about the differences between plans
Learn more about individual insurance plans
Know more individual insurance / ACA 
Know more individual insurance / ACA 
Sources
- Medicare.gov. "Understanding Special Enrollment Periods." Accessed February 2026
- HealthCare.gov. "Qualifying life event." Accessed February 2026
FAQ: Qualifying life events for health insurance
Is Medicare eligibility a qualifying event?
No, becoming eligible for Medicare isn’t considered a qualifying life event. However, assuming you have private health insurance coverage, you can drop your individual health insurance policy when you become eligible and enroll in Medicare.
You can get Medicare starting three months before your 65th birthday and ending three months after you turn 65.
Can I
Yes. You can cancel an individual health insurance policy at any point during the year, even if you didn't experience a qualifying life event. However, you must have experienced a qualifying life event to cancel group health insurance through your employer -- unless you leave the job.
Is a spouse getting a job a qualifying life event?
Yes, a spouse getting a new job counts as a qualifying life event because they lose their previous group coverage. In this case, they can enroll in their new employer's group health insurance plan within 30 days of their start date.
Is getting a new job a qualifying life event?
Yes, getting a new job is a qualifying life event. You will be able to enroll in your new employer's health insurance plan outside of open enrollment.
Is divorce a qualifying event for health insurance?
Yes, divorce is a qualifying life event for health insurance. You'll need a divorce decree or proof of legal separation to take advantage of the SEP.
