Qualifying Life Events for ACA Health Insurance

Navigating health insurance under the Affordable Care Act (ACA) can be complex, especially when you experience changes in life circumstances. Let’s explore the topic of qualifying life events and how they impact your health insurance options.

In a real-life scenario, a woman is facing a change in employment that affects her health insurance coverage. She had previously purchased an ACA plan due to her substitute teaching job but terminated it when she secured a full-time job with health insurance. Now, facing issues at her new job, she considers three options that vary in their health insurance coverage.

What is a Qualifying Life Event?

A qualifying life event (QLE) is a specific change in circumstances that allows you to enroll in or make changes to your health insurance plan outside of the annual open enrollment period. Under the ACA, QLEs include, among others:

Loss of health insurance due to job loss or reduction in hours
Change in marital status (marriage, divorce)
Birth or adoption of a child
Permanent move to a new area

Restarting a Terminated Policy

Once a health insurance policy is terminated, it cannot be restarted. However, you may be eligible for a special enrollment period (SEP) if you experience a qualifying life event within 60 days of terminating your coverage. The SEP allows you to enroll in a new plan, even if you have missed the open enrollment period.

Getting Coverage for a Short Period

If you need coverage for a short period, you can purchase a short-term health insurance plan. However, short-term plans do not cover pre-existing conditions and may have other limitations. Another option is to sign up for a marketplace plan during the open enrollment period, which runs from November 1 to January 15. However, this coverage would not start until the plan’s effective date, which may be after the 90-day waiting period for your work-based coverage ends.

Voluntary vs. Involuntary Job Loss

Whether you voluntarily or involuntarily leave a job is not relevant for QLE purposes. Both types of job loss qualify as QLEs.

Conclusion

Understanding the rules surrounding QLEs and ACA health insurance is crucial for navigating changes in your life circumstances. If you lose health insurance due to a job change, you may be eligible for a SEP or other coverage options. It’s important to seek professional guidance from a licensed agent to explore your options and make the best decision for your health and budget.