Qualifying life events
What, exactly, is a qualifying life event?
A qualifying life event is a big life-changing situation — sometimes planned, sometimes unexpected — that can impact you and your health insurance. Experiencing a significant life change may allow you to change your health plan outside of the annual enrollment period (also called open enrollment).
Qualifying life events include (but are not necessarily limited to):1
Having or adopting a baby
Death of someone who shares your health plan
Moving to a new area
Earning U.S. citizenship
Experiencing a shift in employment status
Loss of health insurance
Special Enrollment Periods
Sometimes Special Enrollment Periods (SEPs) may be offered for other qualifying reasons, such as natural disaster relief or pandemic relief.
Due the public health emergency (PHE) that has been in place during the COVID-19 pandemic, Medicaid renewal has been on hold for over 2 years. If you are asked to renew or recertify your Medicaid (also called redetermination) and you lose your Medicaid coverage, you may qualify for a Special Enrollment Period (SEP).
Types of qualifying life events
Many of life’s big moments may open the door to making changes to your health insurance coverage outside of the regular open enrollment period. Changes can most often be made either 30 or 60 days after the qualifying life event happens.
If you’ve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card for help. Here's a little more about each event that might qualify.
When you experience a major shift in your family life, your benefits may also need to change. Family changes that count as qualifying life events include:
- Getting married
- Bringing children into the family with the birth of a baby, adoption or foster care
- Death of a member enrolled in your health plan
If you've experienced one of these qualifying life events, call the phone number on your member ID card to learn about your options.
When it comes to health insurance, turning 26 is a milestone birthday — it’s time for the baby birds to “leave the nest” of their parents’ health insurance and find their own plans.
If you just turned 26, call the phone number on your member ID card to learn about your options.
Another change that can affect special enrollment eligibility is moving. It could be that you’re relocating to an area where your current coverage isn’t available. Or, you might be moving to an area where your current coverage is available, but there are new plans to consider.
If you've recently moved, call the phone number on your member ID card to learn about your options.
A change in employment status — whether voluntary or involuntary (laid off, dismissed, resigned, quit or retired) — is another qualifying life event.
If you've experienced a job change, call the phone number on your member ID card to learn your options. COBRA may be one of the options you may consider.
If you lose your insurance, it's considered a qualifying life event.
This means if you lost your health insurance in the past 60 days (or more than 60 days ago, but since January 1, 2020) or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes:
- Medicaid or Children's Health Insurance Program (CHIP) coverage
- Job-based coverage
- Individual health coverage
- Eligibility for Medicare
- Coverage through a family member
If you are asked to renew or recertify your Medicaid (also called redetermination) and you lose your Medicaid coverage, you may qualify for a Special Enrollment period.
Are you turning 65?
Turning 65 is another moment in time that’s a qualifying life event. It gives you a chance to look into your opportunities for a Medicare plan.
Medicare, a federal program, serves as the primary source of health insurance for those 65 and older (or those under 65 who may qualify for benefits because of a disability or other circumstance).
To find out who is eligible for Medicare, what you should do if you choose to work past 65, who can enroll in Original Medicare (Parts A and B) or how to apply for more coverage, you can look into Medicare basics.
There are four categories, or parts, of Medicare:
- Part A: Medicare Part A covers hospital insurance — inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
Learn more about Medicare Part A
- Part B: Medicare Part B covers certain medical insurance — doctors' services, outpatient care, medical supplies and preventive services.
Learn more about Medicare Part B
Parts A and B are sometimes referred to as Original Medicare, and they don’t cover everything. Services like dental work, vision exams/eye care and out-of-pocket costs, including deductibles, are not covered.
- Part C: (Medicare Advantage): Medicare Part C/Medicare Advantage is a private health plan combining hospital and medical insurance, plus the potential for additional health benefits.
Find a Medicare Advantage Plan that may be right for you
Learn more about UnitedHealthcare Medicare Advantage (Part C) plans
- Part D: Medicare Part D plans, offered by insurance companies approved by Medicare, add prescription drug coverage to Original Medicare and Medicare supplement insurance plans.
Find a Medicare Prescription Drug Plan that may be right for you
Learn more about UnitedHealthcare Medicare prescription drug (Part D) plans
Find a Medicare plan
If you experience a qualifying life event, sign up right away
In most situations, you’ll need to make changes to your health plan within a specific time frame of the qualifying life event.
- Changes can most often be made either 30 or 60 days after the qualifying life event happen
- Missing this deadline could mean having to wait until the next open enrollment, which could be as long as a year
If you’ve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card.
Need a plan now, but haven’t experienced a qualifying life event?
If you’re between enrollment periods and haven’t experienced a qualifying life event, there are options, like short term insurance, to bridge the gap. That way, you can help assure that you’re not without insurance at any point.
Learn what types of health insurance are available
Get an overview of the different types of insurance to see which one may work best for you — both for right now and to be prepared for open enrollment time.