What is a qualifying life event?

A qualifying life event (QLE) is a change in your life situation that may make you eligible for a Special Enrollment Period (SEP). These life events allow you to enroll in Individual & family health coverage during or outside the annual Open Enrollment Period (OEP), which runs from Nov. 1 through Jan. 15. 

When life circumstances change, SEP protects you and your family so you don't have a gap in health coverage.

Is job loss a qualifying life event?

Job loss can mean many different things: getting let go or fired, a furlough, a layoff, resigning or even retiring early. No matter the reason you left your job, it may qualify as a QLE if you had qualifying health coverage while you were employed and then lost it when you left or lost your job.

Below are a few possible reasons why you might not be eligible for the loss of coverage SEP:

  • Your coverage was terminated for not paying your premium (although you may qualify if your employer coverage ended because your employer didn't pay premiums)
  • The coverage you lost didn't qualify as minimum essential coverage
  • You voluntarily end your prior coverage before ending your employment
  • You lost coverage more than 60 days ago
  • You don't provide the required documentation as requested by the Marketplace

Enrolling during your Special Enrollment Period

First, you will shop and compare Individual and family plans. After you choose your plan, click on Enroll and you'll be guided through the process.

If you've already lost coverage

  1. Pick a plan within 60 days after the date your coverage ended
  2. Submit documents showing the lost coverage and the date it ends within 30 days of picking a plan
  3. Coverage will start the first day of the month after you pick a plan

If you're losing coverage in the future

  1. Pick a plan within 60 days before the date your coverage will end
  2. Submit documents showing the lost coverage and the date it ends within 30 days of picking a plan
  3. Coverage will start the first day of the month after your coverage ends and you pick a plan

Keep in mind, you can't use your coverage until you confirm you qualify and you pay your first premium payment.

Check if you're eligible for a subsidy, even if you don't think you'll qualify.

  • Subsidies are more widely available thanks to the American Rescue Plan and Inflation Reduction Act.
  • You may qualify for a premium tax credit if your income is between 100-400% of the federal poverty level.
  • You may also qualify for extra savings known as "cost-sharing reductions." These save you a second way by lowering out-of-pocket costs when you get medical services.
  • You'll only see cost-sharing reductions on Silver plans so you must shop for and purchase a Silver plan to see and qualify for cost-sharing reductions.

Learn more about how to save on health coverage.

Frequently asked questions

What is minimum essential coverage?

Minimum essential coverage (MEC) is any plan that meets the Affordable Care Act (ACA) requirements for having health coverage.

Plans that qualify as MEC include:

Employer-sponsored plans

  • Current employees
  • Retiree coverage

Government plans

  • Medicaid
  • Medicare
  • Tricare
  • Children's Health Insurance Program (CHIP)

Individual plans

  • An Individual health plan you enrolled in through the Marketplace (or had before the ACA went into effect and were allowed to keep it)

Plans that are not considered MEC include:

  • Dental and vision plans
  • Accident supplement insurance
  • Worker's compensation
  • Health discount plans
  • Heath care sharing ministries

What documents can I submit for coverage?

Documents must show that you lost qualifying health coverage in the past 60 days or will lose coverage in the next 60 days. These documents must include your name and the date of coverage loss.

Documents you can submit for job loss:

A letter from an employer, on official letterhead or stationery, that confirms one of these:

  • That your employer dropped or will drop your coverage or benefits
  • That your employer stopped or will stop contributing to your cost of coverage
  • That your employer changed or will change coverage or benefits, and your coverage will no longer be considered qualifying health coverage

If your COBRA is ending:

A letter about COBRA coverage, like a letter from an employer or health insurance company that confirms these:

  • Your employer's offer of COBRA coverage along with the date this coverage would start
  • Your COBRA coverage ended or will end, or your employer stopped or will stop contributing to the cost of coverage and when

From healthcare.gov

Can my spouse and dependents be covered after job loss?

Yes, but only if your spouse and dependents also lost their job-based coverage when you left your job.

If you're offered coverage through a spouse's plan, you can still enroll in a Marketplace plan but it may affect your eligibility for premium tax credits and cost-sharing reductions. 

I was offered COBRA through my employer. What is COBRA?

COBRA stands for the Consolidated Omnibus Budget Administration Act. COBRA allows you to keep your group health coverage when you lose your employer-based health coverage under certain circumstances. COBRA also covers your spouse and any dependents on your plan.

Here are some things to keep in mind about COBRA as you make a decision about your health coverage:

  • If your employer-sponsored health plan is covered under COBRA, you'll get COBRA insurance as an option if you quit or lose your job.
  • Being offered COBRA continuation coverage doesn't mean you're ineligible for coverage through an Individual health plan or for a tax credit.
  • Typically you have at least 60 days after you lose your employer-sponsored health insurance to decide whether you want to enroll in COBRA.
  • If you elect COBRA coverage, employers may require you to pay the full cost of the coverage, plus an administration charge.
  • The COBRA coverage premium is often more expensive than you're used to paying, because employers usually pay part of the cost of coverage for active employees.
  • COBRA coverage typically ranges from 18 to 36 months, which you have to use without interruption. If you choose to terminate your COBRA coverage, you cannot start it up again.

If you choose to enroll in COBRA, you can switch to a Marketplace plan only if you've used up your COBRA coverage, you have another qualifying event or it's OEP.

How do I choose a plan?

There are many options for health plans on the Marketplace, and the task of finding the right one may appear overwhelming at first. Knowing a few things beforehand will help you feel prepared as you shop and enroll in an Individual & family health plan.

Here are some costs that will be referred to in each plan:

Premium: The amount you pay to your insurer each month in exchange for health coverage.
Deductible: The amount you pay each year before the health plan starts to pay for certain services. A lower deductible will have a higher premium.
Copayment: A set amount you pay at the time you receive health care services or prescriptions. An example is paying a $20 copay each time you see your primary care provider.
Coinsurance: A percentage of the cost of health care services or prescriptions. An example is paying 20% of the cost of an X-ray.

Think through these questions as you consider a plan:

  • What is your budget? (Keep in mind, if you qualify for a premium tax credit to help subsidize your cost, it can be paid to your insurance plan for you each month.)
  • Do you have a chronic condition? Look for a plan that's committed to helping keep your chronic condition under control.
  • Is it important that you keep your same provider? If so, you'll want to check that they are in-network for the plan you're looking at.
  • Do you take any prescription drugs? If so, you'll want to look for good prescription coverage and make sure the medication you're taking is covered under the plan you're looking at. These can be found in the plan's "formulary."
  • Do you frequently visit the doctor or a specialist, or need X-rays or other tests, be sure to add in the cost of copays and coinsurance into your budget. If you qualify for cost-sharing reductions and enroll in a Silver plan, you can save on these out-of-pocket costs. Learn more.
  • Are you interested in added benefits to help keep you at your healthiest? Look for a plan that gives you added benefits, discounts and perks to save you even more.

Priority Health works for you

  • One of the largest individual networks of primary care doctors in Lower Michigan and in metro Detroit
  • Our four-star rating on the Marketplace* shows that we give you more for your money and do more to improve your health
  • Local, reliable customer service that makes your need a priority
  • A Michigan-based company committed to investing in communities to improve health, instill humanity and inspire hope
mom and dad with two young kids in front yard of home

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* CMS scores qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS) based on third-party validated clinical measure data and QHP Enrollee Survey responses. CMS calculates ratings yearly on a 5 star scale. Ratings may change from year to year.