Understanding Qualifying Life Events

Can I purchase insurance if I missed open enrollment?

One of the most common questions we receive as North Carolina health insurance agents, is from people who need to purchase health insurance outside of the open enrollment period. Many customers call or email us wondering if they are still able to purchase health insurance if they’ve missed the open enrollment period, and what to do if they cannot. With a little less than a week left to purchase 2015 insurance, we thought we’d break it down here.

The short answer is this. It is possible to purchase health insurance coverage outside of the open enrollment period. However, you may only qualify for a Special Enrollment Period in certain circumstances, often referred to as qualifying life events (QLE).

What are qualifying life events?

Qualifying life events are certain life changes that may require a change in your insurance coverage needs. Qualifying life events include:

  • Having a baby, adopting a child, or placing a child for adoption.
  • Getting married.
  • Losing other health coverage by losing a job-based plan, aging off your parents’ coverage at age 26, divorce, or losing eligibility for Medicaid or CHIP.
  • Being denied Medicaid or CHIP coverage.
  • Moving your residence outside your insurance plan’s service area.
  • Gaining citizenship.
  • Gaining status as a member of a federally recognized tribe or shareholder in an Alaska Native Claims Settlement Act (ANCSA) Corporation.
  • Leaving incarceration.
  • Experiencing a change in income or household status that will affect eligibility for premium tax credits or cost-sharing reductions for those enrolled in Marketplace coverage.
  • You or your dependents’ enrollment or non-enrollment in another benefit health plan was made as a result of an error by the Health Insurance Marketplace.
  • You or your dependents’ demonstrated that the health benefit plan you were previously enrolled in substantially violated material provisions of the contract.

How long after a QLE will I have to apply for insurance coverage? When will it take effect?

The answer to this question may vary based on the specific qualifying life event. For example, when you have a baby, adopt a child or place a child for adoption your new coverage can take effect the same day of the event, and you will have a 60-day enrollment window after the event to apply for coverage. In most other cases, such as getting married, your coverage will not take effect until the first day of the month after you enroll.

Most qualifying life events have a 60-day window before or after the event to apply for new insurance, though different situations may have different limitations.

How do I apply for insurance with a Special Enrollment Period?

If you are unsure of whether you qualify for a Special Enrollment Period, we are happy to help. Give The Wooten Agency a call today, or fill out our free consultation request here, to speak with one of our knowledgeable health insurance agents.

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Regardless of whether you purchase a policy or not, we are always happy to help in any way we can.

Client Testimonials

Can I Apply for Insurance if I Missed Open Enrollment? | Wooten Agency

  • "This is a family-owned business who cares about their potential clients. I was looking for help with health insurance and even though it turns out I don't need new health insurance at this time, I feel compelled to write a review because of how thorough Brendan was. He was very knowledgeable and easy-going. He didn't seem pushy at all and listened to everything I had to say. He made sure he was getting all the information correct. I would recommend this agency for any insurance needs." - - Cary, NC
  • "I sought help from Wooten Agency; Ed, along with Nancy, took the bull by the horns and sorted things out for us very quickly. Shortly thereafter Ginny took over. She is definitely most qualified as a plan selector for Medicare plans and issues related to Medicare. My appreciation to Crystal for the gracious way she always responds to telephone calls and makes every effort to ensure one is not forgotten. And Dana....the one contact we had was enough to find out you are similarly inclined to help a client." - - Raleigh, NC
  • "You [Aaron] have been so helpful, and you have all taken a personal interest in my individual and specific questions in order to make the best insurance choices for my needs. Thank you all! I look forward to working together in the future months and years." - - Morrisville, NC

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