A Qualifying Life Event (QLE) is a specific event or change in circumstances that allows an individual to enroll in or change their health insurance coverage outside of the annual Open Enrollment Period

• Loss of health coverage: This includes the loss of job-based coverage, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, and other situations where you lose your health coverage.
• Change in household size: This includes marriage, divorce, legal separation, birth, adoption, or placement for adoption, or death of a family member.
• Changes in residence: This includes moving to a new address that is outside your current health plan's service area.
• Changes in income or eligibility for subsidies: This includes changes that affect your eligibility for premium tax credits, cost-sharing reductions, or Medicaid or CHIP.
• Income does not exceed 150% of Federal Poverty Limit: (This QLE is currently paused until Dec. 2026) Under this special enrollment period, eligible applicants can enroll in an ACA compliant health plan through the Marketplace at any time during the year. Coverage will take effect on the first of the following month
• Enrollment errors: This includes errors made by the Marketplace or health plan, such as enrolling in the wrong plan or being denied coverage when you were eligible.
• Other exceptional circumstances: This includes situations such as natural disasters, domestic abuse, or unexpected medical expenses that may qualify you for a special enrollment period

Income to Qualify for 150% FPL

Household Size (HH): (100% - 150%) Dollars per Year

• Household Size (1) - $15,650.00 - $23,475.00
• Household Size (2) - $21,150.00 - $31,725.00
• Household Size (3) - $26,650.00 - $39,975.00
• Household Size (4) - $32,150.00 - $48,225.00
• Household Size (5) - $37,650.00 - $56,475.00
• Household Size (6) - $43,150.00 - $64,725.00
• Household Size (7) - $48,650.00 - $72,975.00
• Household Size (8) - $54,150.00 - $81,225.00

Note: Keep in mind that if your household makes less than 100% of the Federal Poverty Level (FPL), you may not qualify for an Advanced Premium Tax Credit Subsidy

QLEs are necessary because they allow individuals to make changes to their health insurance coverage when they experience a significant life event that affects their insurance needs. Without QLEs, individuals would be limited to enrolling or making changes to their health insurance coverage only during the annual Open Enrollment Period. This could leave individuals without coverage or with inadequate coverage during times when they need it the most.

QLEs are also important for maintaining a stable risk pool in the individual insurance market. Without the ability to enroll or change coverage outside of Open Enrollment, healthy individuals may be more likely to go without insurance, leaving a higher concentration of sick individuals in the risk pool. This could drive up premiums for everyone in the market. By allowing individuals to enroll or change coverage outside of Open Enrollment when they experience a QLE, the risk pool can remain more stable and premiums can be more affordable.