Qualifying Life Events

List of Life Changing Events That Allow You to Enroll During the Special Enrollment Period

If you wish to enroll in a health plan and it’s not currently the open enrollment period, you will need to have a qualifying life event to get health insurance.

This is generally a significant change that occurs in your life. It could be a change to your family, your residence, your previous health coverage, or a number of other things. Without a life event you won’t be able to enroll in a new plan until the next open enrollment period.

Each of these IRS qualifying life events has specified requirements in order for for you to be eligible to apply for health insurance during special enrollment. Click on the list of qualifying life events for health insurance below for more information.

 

Lost my health insurance including Medi-Cal
Permanently moved to/within California
Had a baby
Adopted a child
Got married
Entered into domestic partnership
Returned from active duty military service
Released from incarceration
Gained citizenship/lawful presence
American Indian/Alaskan Native
Other qualifying life event
None of the above

 

If you’ve lost your health coverage in the last 60 days, or will soon lose it soon, you may qualify for special enrollment. In order to qualify you must not have lost your coverage voluntarily. That means, for example, you do not qualify if your coverage was cancelled because you weren’t able to pay for it. However, if you had employer-sponsored coverage and lost your job you probably lost your coverage as well. In this case you do qualify and may enroll in a plan as long as your loss of coverage occurred in the last 60 days.

Another common example is someone who loses their Medi-Cal coverage. Perhaps you’ve been on Medi-Cal for a while and then you receive a raise on your job or start working more hours. If your increased income pushes you above the threshold for Medi-Cal and it’s cancelled, you qualify for special enrollment.

More examples:

COBRA coverage expires (cannot be for non-payment)
You don’t qualify for student health coverage anymore
You don’t qualify for a family plan anymore because you turned 26
You don’t qualify for a child-only plan anymore because you turned 19

 

If you moved to California from another state in the last 60 days, you qualify for special enrollment.

If you moved within California, from one residence to another, you MAY qualify for special enrollment. In order for this to be the case, there must be at least one plan available to you at your new address that was not available to you before.

 

If you had a baby, adopted a child, or received a child into foster care in the last 60 days you qualify for special enrollment.

Also, you qualify for special enrollment if your child was placed for adoption or foster care.

Note:
If your qualifying event involves foster care you will need to select “adopted a child”

 

If you adopted a child, had a baby, or received a child into foster care in the last 60 days you qualify for special enrollment.

Also, you qualify for special enrollment if your child was placed for adoption or foster care.

Note:
If your qualifying event involves foster care you will need to select “adopted a child”

 

If you got married in the last 60 days, you and your spouse qualify for special enrollment and may purchase a health plan.

 

If you entered into a legally recognized domestic partnership in the last 60 days, you and your partner qualify for special enrollment and may purchase a health plan.

 

If you’ve lost coverage in the last 60 days due to leaving active duty, reserve duty, or the California National Guard, you qualify for special enrollment and may purchase a health plan.

 

If you were released from jail or prison in the last 60 days, you qualify for special enrollment and may purchase a health plan.

 

This is one of the most common qualifying life events for insurance. If you became a citizen, a national, or a permanent legal resident of the U.S. in the last 60 days, you qualify for the special enrollment period and may purchase a health plan.

 

If you are a federally recognized American Indian/Alaskan Native and are a part of a federally recognized tribe, you can enroll at any time throughout the year regardless of enrollment period. You may also change health plans up to once a month.

 

If none of the events listed above apply to you, you may be able to select “Other Qualifying Life Event” if:

  • you currently have a Covered California plan and become eligible or ineligible cost sharing reductions or tax credits.
  • when you applied, misconduct or misinformation occurred on the part of your authorized representative.
  • you’ve recently become eligible for COBRA.
  • you’re enrollment was affected by technical issues on Covered California’s website.
  • your health plan violated it’s contract.
  • you experienced a natural disaster or medical emergency near the open enrollment deadline.
  • Health and Human Services issued you a certificate of exemption but you lost exemption outside of open enrollment.
  • a child you’ve been ordered to provide insurance for is ineligible for Medi-Cal and CHIP, regardless of whether or not you plan to claim the child on your taxes.
  • you entered AmeriCorps/VISTA/National Civilian Community Corps outside of an open enrollment period.
  • you ended your time with AmeriCorps/VISTA/National Civilian Community Corps outside of an open enrollment period.
  • you’re currently on a “grandfathered” plan and would like to switch to a Covered California plan.
  • your provider left the network while you were being treated for any of the following:
    • pregnancy
    • terminal illness
    • an acute condition
    • a serious chronic condition
    • the care of a newborn between 0 and 36 months
    • a surgery or other procedure that will occur within 180 days of the termination or start date.

 

None of the above

If you do not have a life qualifying event you can still apply for Medi-Cal or Access for Infants and Mothers (AIM) based on your income and family size regardless of enrollments periods. Your health insurance application will be screened for eligibility in these programs no matter which qualifying event is selected.