What is Qualifying Life Event?

A Qualifying Life Event (QLE) is a specific event that triggers a change in an individual’s insurance coverage status. It allows individuals to make changes to their insurance coverage outside of the regular enrollment period. These events include things like getting married, having a child, losing other coverage, and experiencing changes in income or residency. Examples of QLEs are, job loss, divorce, marriage, birth or adoption of a child, moving to a new area, and changes in income. Under the Affordable Care Act (ACA), an individual who experiences a QLE is allowed to enroll in or make changes to their health insurance plan outside of the regular open enrollment period.

What are the four categories of Qualifying Life Events?

The Qualifying Life Events are divided into four categories:

  1. Loss of Health Insurance: such as turning 26 and losing coverage through a parent’s plan, losing job-based coverage, not passing the eligibility for Medicare or Medicaid, and losing insurance for any other reason except non-payment of premiums.
  2. Change in household: such as getting married, having a baby, adopting a child, receiving a foster child, or the death of a dependent.
  3. Changes in residence: like moving to a different city, moving to or from school or work location, moving in or out of a shelter or transitional housing, or moving to the U.S. from a U.S. territory or foreign country.
  4. Other qualifying changes: such as changes in income that affect Medicaid eligibility, becoming eligible for tax credits to lower premiums, becoming a member of a federally recognized tribe, new U.S. citizens becoming eligible for marketplace coverage, AmeriCorps VISTA members beginning or ending service, or being released from incarceration.
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