A qualifying event (also called a qualifying life event, or QLE) is a major change in your circumstances that lets you sign up for health insurance outside of the annual Open Enrollment Period. Normally, you can only enroll in or switch health plans during Open Enrollment, which runs from November through mid-January for Marketplace plans. But if something significant happens in your life, like losing your job-based coverage, getting married, or having a baby, you get a Special Enrollment Period that typically lasts 60 days before or after the event.
Qualifying events fall into four main categories: loss of health coverage, changes in your household, changes in where you live, and a handful of other specific circumstances. Here’s what counts in each category and what you need to know to use one.
Loss of Health Coverage
This is the most common trigger. If you lose health insurance for reasons outside your control, you qualify. That includes losing a job-based plan (whether you quit, get laid off, or your hours are reduced), losing individual or student coverage, losing eligibility for Medicaid or CHIP, or turning 26 and aging off a parent’s plan. Each of these opens a window to enroll in a new Marketplace plan or, in many cases, an employer plan.
One important distinction: voluntarily dropping your coverage doesn’t count. If you simply stop paying premiums and let your plan lapse, that’s not considered a qualifying event. The loss has to be involuntary or the result of a life change you didn’t choose.
Changes in Your Household
Life events that change the size or structure of your household also qualify. The major ones are:
- Getting married. Marriage opens a Special Enrollment Period for both spouses, whether you want to join one partner’s employer plan or enroll together in a Marketplace plan.
- Getting divorced. If your divorce means you lose coverage through a spouse’s plan, that counts as both a household change and a loss of coverage.
- Having a baby or adopting a child. A new child qualifies you to enroll in coverage or add the child to an existing plan. Notably, pregnancy alone is not a qualifying event on the Marketplace. The Special Enrollment Period triggers at birth or adoption, not at a positive pregnancy test.
- A death in the family. If you lose coverage because a family member who held the plan passes away, you can enroll in new coverage.
When a baby is born or a child is adopted, coverage can often be backdated to the date of birth or placement. This is one of the few situations where your new plan can start retroactively rather than on the first of the following month.
Changes in Residence
Moving to a new ZIP code or county qualifies you to enroll in a plan, but there’s a catch many people miss: you generally need to prove you had qualifying health coverage for at least one day during the 60 days before your move. You can’t use a move as a workaround to get insurance if you’ve been uninsured for months. The exception is if you’re moving to the U.S. from a foreign country or U.S. territory, in which case no prior coverage is required.
Beyond a standard household move, several other residence changes qualify:
- Students moving to or from the area where they attend school
- Seasonal workers moving to or from the place they both live and work
- People in transitional housing moving to or from a shelter
If you’re homeless or living in transitional housing, you can verify your residence with a letter from someone in your state who can confirm where you live, such as a friend, family member, or caseworker.
Other Qualifying Circumstances
A few less common situations also trigger a Special Enrollment Period:
- Income changes that affect what coverage or financial help you qualify for
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder
- Becoming a U.S. citizen
- Leaving incarceration (jail or prison)
- AmeriCorps members starting or ending their service
Exceptional circumstances can also qualify, though these are handled case by case. If a natural disaster, serious medical emergency, or an error by an insurance agent prevented you from enrolling during a normal window, you may be granted additional time.
How Long You Have to Enroll
For most qualifying events on the Marketplace, you have 60 days from the date of the event to select a new plan. Some events, like an upcoming move or anticipated loss of coverage, let you start the process up to 60 days before the change actually happens.
Employer-sponsored plans typically give you a shorter window of 30 days from the qualifying event. This is set by federal benefits law rather than the Marketplace rules, so if you’re enrolling through your job, pay close attention to your employer’s specific deadlines. Missing the window by even a day can lock you out until the next Open Enrollment.
Documentation You’ll Need
When you report a qualifying event on the Marketplace, you’ll usually be asked to upload documents proving it happened. The specifics depend on your situation. For a loss of coverage, you’ll need something showing the coverage existed and when it ended, like a termination letter from your insurer or employer. For a move, you’ll need proof of your new address and proof you had prior coverage. For a birth, marriage, or adoption, the relevant certificate or court order is the standard documentation.
If you’ve tried everything and genuinely can’t get the right documents, the Marketplace allows you to submit a letter of explanation instead. This is a form you fill out describing your life event and why you can’t provide standard proof. It’s not a guaranteed pass, but it exists as a backup.
A Note on Low-Income Enrollment
For several years, people with incomes below 150% of the federal poverty level could enroll in Marketplace coverage year-round through a special low-income enrollment period, no qualifying event needed. That provision is set to end on August 25, 2025. After that date, low-income individuals will need a qualifying life event or will need to wait for Open Enrollment like everyone else, unless they qualify for Medicaid in their state.